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Bulletin 



OF THE 

SCHOOL OF MEDICINE 



UNIVERSITY OF MARYLAND 



Vol. 3 6 

195. 1 




L. 4- 







OF 

THE SCHOOL OF MEDICINE 

UNIVERSITY OF MARYLAND 

volume 36 January, 1951 number i 

EDITORIAL 
ABDOMINAL PAIN 

As time goes on, there are more and more laboratory aids and scientific tests to 
point to correct diagnoses of diseases and conditions that are not normal. It is nat- 
ural that we should lean more on the new and less on the old. There are countless 
illustrations of this over the ages, but it is not the part of wisdom to discard or dis- 
count fundamental symptoms and signs that are nature's way of issuing warnings. 

Pain is, of course, a fundamental symptom of many conditions. It is unfortunate 
that some of our worst diseases do not in their early stages give rise to this signal. 
When it does occur, it justifies all the consideration given it by our predecessors 
and more, for we have the benefit of modern knowledge that has been developed in 
the fields of anatomy, physiology and pathology, which add to the value of this 
symptom. One seems to note, however, in recent years a certain indifference or 
casualness in the attempts at its interpretation. It is not meant that there is indiffer- 
ence to its relief, but to question whether it is always given the careful analysis that 
can be so very revealing. 

In considering pain, it is probably more important than in most any other com- 
plaint, to evaluate the patient first and the symptom second, and in this problem 
there are dangers. It is safer in most instances to err on the side of believing rather 
than disbelieving. 

In a brief article one cannot discuss the vagaries of children, the malingering of 
those receiving compensation, and other cases in litigation, nor the hysterics. In the 
usual bona fide cases, one should carefully listen to the description of the pain, at- 
tempting to get the patient to tell in his own words just what is felt. The choice of 
words in many of these histories is very descriptive. 

We cannot here go into a detailed scientific discussion of pain. It is a most com- 
plex subject and it is wondered whether sufficient attention is paid to it per se in 
our teaching. If the complaint is in the abdomen one should take the time to obtain 
from the patient the characteristics of the pain; whether deep or superficial, dull or 
sharp, local or general, steady or rhythmic; whether it is throbbing; whether re- 
ferred along well established paths: are the pain and tenderness in the same area; 
is there rigidity; is there nocturnal or diurnal emphasis; does the position of the pa- 
tient influence the severity; is the pain accompanied by visible peristalsis and bor- 
borygmi. 



2 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF AID. 

It should be remembered that strangulations of bowel are likely to give more ag- 
gravated symptoms than obturator types of obstruction. Evans and Bigger, in the 
J. A. M. A. February 22, 1947 state: 

"Pain is the commonest symptom in obstruction of the small bowel. Although it 
is generally stated that in both types of obstruction the onset is sudden, we are im- 
pressed by the dramatic onset of pain in strangulating obstruction; it is likely to 
be sudden and severe, even violent. In this respect the patient with strangulation 
resembles those of other clinical states where the flow of blood to a part is suddenly 
obstructed as in coronary occlusion or embolus to a main artery of an extremity. In 
simple obstruction the patient may recall that in the earliest hours there had been 
abrupt, periodic increase and cessation of the pain, but in strangulation the pain is 
generally continuous without intervals of complete freedom from pain". 

A large bowel obstruction not caused by strangulation may be accompanied by 
little pain, and when it is present there may be surprisingly long intervals between 
paroxysms, thus throwing the doctor off guard. The patient seems at times to have 
been relieved — only to have other paroxysms. A Wangensteen suction will in many 
instances relieve the pain of obstruction and while being helpful may lull the pa- 
tient and doctor into greater danger. 

One has only to review cases in retrospect to realize that a more critical analysis 
of the type of pain might have lead to a more correct diagnosis. More care might 
have promptly pointed to the chest condition giving abdominal symptoms, or an 
abdominal condition giving chest symptoms, or cerebro spinal disease giving ab- 
dominal symptoms. We find instance after instance where the persistence of pain 
finally leads to the diagnosis of biliary tract disease, colonic growths and other con- 
ditions in spite of negative roentgenologic and laboratory findings. 

Many examples of interesting and confusing problems could be cited but perhaps 
enough has been said to emphasize the importance of paying attention to the pa- 
tient's complaint of pain. An attempt should be made to analyze pain on its own 
characteristics, with corroboration from available tests. It is not wise to depend 
entirely on laboratories to tell what nature in her outcry may be saying rather 
plainly. 

Walter D. Wise, M.D. 



CANCER DETECTION AND THERAPY 

II. Methods of Preparation and Biological Effects 
of Metallo-Porphyrins* f t 

LOUIS 0. J. MANGANIELLO, M.D.§ and FRANK H. J. FIGGE, Ph.D. 

In a previous paper (1), the affinity of neoplastic and growing tissue for porphyrins 
and metallo-porphyrins (zinc hematoporphyrin) was reported. When mice with in- 
duced (methylcholanthrene) or transplanted tumors (Sarcoma 37, Sarcoma 180) and 
a dog with a spontaneous mammary tumor were injected with radioactive zinc hema- 
toporphyrin, the tumors became very red fluorescent, although not as radioactive 
as had been anticipated. On the other hand, the liver became two or three times as 
radioactive as the tumor, and contained very little porphyrin. Further investigation 
involving the injection of radioactive zinc hematoporphyrin into normal dogs, rab- 
bits, and mice, confirmed the impression that zinc 65 was split off the porphyrin and 
stored in the liver. 

It thus became desirable to test other more stable metal porphyrin compounds in 
the hope of finding one or more that would not be broken down in the liver. When 
the methods for synthesizing metallo-porphyrin compounds were examined, it was 
found that in some instances the existing methods were quite simple. However, some 
metals had not been introduced except by pressure bomb synthesis (vanadium) (2) 
because the solvents commonly employed boiled far below the temperature neces- 
sary for the reaction. It appeared probable that any metal porphyrin complex could 
be made if a mutual solvent for the metal salts and the porphyrin, with a boiling 
point near 200° Centigrade could be found. Ethylene glycol with a boiling point 
near 200° Centigrade was tried and proved to be ideal in every respect. In addition, 
it was miscible with water and the boiling point could thus be regulated. 

The method involving the use of ethylene glycol as a solvent will be described 
below. For comparison of yields and properties of the compound made by other 
methods, the preparation of zinc hematoporphyrin will be described. The fate of 
this compound in the bodies of animals with tumors will be discussed. 

METHOD. AND MATERIALS 

Preparation of Zinc Hematoporphyrin 

method 1— method of fisher, treibs and hummel as modified by glenn s. weiland 

(methyl-alcohol method) 

Five hundred mg. (0.74 millimoles) of hematoporphyrin dihydrochloride is dissolved in 30 ml. of 
50 per cent (v/v) solution of methanol and added with vigorous stirring at room temperature to a 
solution of 330 mg. (1.48 millimoles) of zinc acetate dihydrate dissolved in 15 ml. of methanol. Some 

* This work was supported by grants from the Anna Fuller Fund, the Damon Runyon Fund and 
Merck & Company, Inc. 

f From the Departments of Neurosurgery and Anatomy of the University of Maryland School 
of Medicine, Baltimore, Maryland. 

t Received for publication November 2, 1950. 

§ Fellow in Neurosurgery. Fund B. 

3 



4 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

precipitation of the zinc porphyrin appears. After a few minutes, while stirring vigorously, there is 
added to the mixture 50 ml. of water. The precipitated metal porphyrin is then filtered and washed 
3 or 4 times with 30 ml. of water until the filtrate is free of zinc and chloride ions. The material is 
dissolved in dioxane which is then evaporated in a hood. The yield by this method is 648 mg. of 
zinc hematoporphyrin. 

METHOD 2 — ETHYLENE GLYCOL METHOD 

Five hundred mg. of hematoporphyrin dihydrochloride is dissolved in 200 cc. of ethylene glycol. 
Next, 350 mg. of zinc acetate dihydrate is dissolved in 25 cc. of ethylene glycol. Both solutions are 
heated to 90 C. and mixed with vigorous shaking. Heating is continued until the solution changes 
from a red fluorescent color to an orange-yellow fluorescence. Next, 750 cc. of water is added. When 



TABLE I 

Solubility and Fluorescence of Zinc Hematoporphyrin Samples in Various Solvents 



Acetic acid 

Acetone 

Ethyl acetate . . 
Ethyl alchol . . . 
Methyl alcohol 

Ether 

Dioxane 

Ethylene glycol 

Benzine 

Pyridine 

NaOH l.N. ... 
Water pH 10 . . 
Water pH 8... 
Water pH 7 . . . 

Water pH 5 

0.1 NHC1 

1 N HC1 

2 NHC1 

H 2 SOi 



ETHYLENE GLYCOL METHOD 



METHYL ALCOHOI METHOD 



Soluble 


Fluorescence 


Soluble 


Fluorescence 


slightly 


yellow-orange 


slightly 


yellow-orange 


slightly 


yellow-orange 


slightly 


yellow-orange 


slightly 


yellow-orange 


slightly 


yellow-orange 


slightly 


yellow-orange 


slightly 


yellow-orange 


slightly 


yellow-orange 


slightly 


yellow-orange 


slightly 


yellow-orange 


slightly plus 


yellow-orange 


soluble 


yellow-orange 


soluble 


yellow-orange 


slightly 


yellow-orange 


slight lv 


yellow-orange 


slightly 


? 


slightly 


yellow-orange 


soluble 


red-orange-yellow 


soluble 


orange-yellow 


very 


dark yellow 


very 


light yellow 


soluble 


orange-yellow dark 


soluble 


orange-yellow 


soluble 


orange-yellow dark 


soluble 


orange-yellow light 


slightly 


orange-yellow dark 


slightly 


orange-yellow light 


insoluble 


nonfiuorescent 


insoluble 


nonfiuorescent 


insoluble 


slightly red 


insoluble 


slightly red 


slightly 


orange-yellow 


slightly 


orange-yellow 


slightly 


orange-yellow 


slightly 


orange-yellow 


decomposed 


dark red 


decomposed 


dark red 



warmed, a flocculant precipitate forms, which settles out on standing. After removal of the superna- 
tant liquid, the precipitate is filtered and washed three to four times with distilled water. The pre- 
cipitate is then collected by dissolving it in dioxane and is weighed after the evaporation of this 
solvent (in hood). The yield by the above is 461 mg. zinc hematoporphyrin. 

RESULTS 

Comparison of the Yields, and Properties of the Products 

The fact that the yield by the methyl alcohol method was considerably higher 
(641 mg) than the yield with the ethylene glycol method (461 mg) was related to 
the fact that the product obtained by the methyl alcohol method was a gummy 
resin-like substance that could not be completely dried. In contrast, the material 
obtained by the ethylene glycol method was a fine dry powder. The solubility and 
fluorescence of the preparations were determined and listed in Table I. 



MANGANIELLO AND FIGGE— CANCER DETECTION AND THERAPY 5 

Ten mg. of the zinc hematoporphyrin of each sample was placed in 20 cc of sol- 
vent. The degree of solubility and fluorescence color and intensity were estimated 
by visual inspection and comparison. The solutions were examined two hours after 
preparation and again, one week later (see Table I). The fluorescence and absorp- 
tion spectra were determined by means of a Hartridge reversion spectroscope. The 



TABLE II 

Fluorescence and Absorption Spectra of Zinc Hematoporphyrin 





METHYL ALCOHOL METHOD 


ETHYLENE GLYCOL METHOD 


SOLVENT 


Fluores- 
cence band 
(Angstrom 
units) 


Absorption bands 
(Angstrom units) 


Fluores- 
cence band 
(Angstrom 
units) 


Absorption bands 
(Angstrom units) 




Edge 


Center 


Edge 


Edge 


Center 


Edge 


Acetic acid 


619.2 

577.5 


584.0 
551.1 


575.4 
537.0 


566.4 

525.4 


619.2 

577.4 


587.1 
551.2 


576.5 
538.1 


568.2 
526.0 


Acetone 


611.8 
570.4 


586.5 
553.4 


575.6 
539.0 


565 . 7 

523.5 


612.8 

571.8 


585 . 8 
551.8 


576.3 
539.9 


560.1 

529.0 


Dioxane 


609.2 
571.4 


586.3 

553.8 


576.2 
538.8 


566.4 
521.0 


610.8 
571.8 


587.6 
554.6 


577.3 
538.8 


567.1 

523.8 


Ethylene 
glycol 


627.8 
571.5 


582.5 
550.2 


577.4 
540.6 


572.6 
528.0 


627.8 
571.5 


583.5 
549.6 


578.0 
540.4 


571.2 
530.8 


Methyl 
alcohol 


625.8 
585.6 


585.4 
553.4 


576.3 
539.8 


569.8 
528.0 


625.8 
583.7 


589.8 
556.0 


577.9 
539.9 


568.5 
524.0 


NaOHO.lN 


624.6 
572.8 


589.2 
554.5 


578.6 
539.8 


568.2 

524.8 


625.2 

572.8 


589.8 

554.2 


580.0 
541.2 


569.9 
525.6 



data were recorded in Table II. These spectroscopic data made it possible to identify 
the porphyrins or metalloporphyrins in the tissues, even without extraction. To per- 
mit differentiation, similar absorption and fluorescence spectra were determined for 
hematoporphyrin and hemin. These are also listed in Table II-A. Attempts to deter- 
mine the melting points of the above compounds were unsuccessful. 

A number of other metal porphyrins have been prepared by the ethylene glycol 
method. These compounds and their biologic effects will be described later. 



6 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

An attempt was made to determine the toxicity of zinc hematoporphyrin and 
zinc 65 hematoporphyrin. Experience with the injection of hematoporphyrin into 
animals (mice, rabbits and dogs) and human subjects led to the conclusion that 
hematoporphyrin itself was not as toxic as reports indicate (3). Mice readily tol- 
erated doses of 10 mg. of hematoporphyrin if they were not exposed to direct sun- 



TABLE II-A 

Fluorescence and Absorption Spectra of Hematoporphyrin HCl and Heme 





HEMATOPORPHYRIN HCl 


HEME 


SOLVENT 


Fluorescence band 

A 


Absorption bands 

A 

Center 


Absorption bands 

A 

Center 


Acetic acid 


605.6 


598.9 
573.6 








554.3 


546.0 






526.6 




Acetone 


626.1 


624.4 
590.5 


643.2 






570.6 


589.9 






532.3 




Dioxane 


626.2 


623.1 
596.9 


643.7 






574.4 


547.4 






532.9 


519.3 


Ethylene glycol 




603.8 






610.4 


563.9 
529.4 
496.0 


618.3 


Methyl alcohol 




603.0 


625.9 (wide) 




610.1 


563.0 
526.9 
497.0 




NaOHO.l N 


616.4 


620.2 
569.5 






609.4 






540.0 








502.7 





light. Rabbits were given 25 to 50 mg. of hematoporphyrin with no undesirable 
effects. It was noted that when normal mice, or mice with tumors, were injected 
with metalloporphyrins, the mice with tumors tolerated a much larger dose than 
the normal mice. A preparation of zinc 65 hematoporphyrin, prepared by the Trac- 
erlab Company under direction of Glenn S. Weiland, was injected into normal mice 
with transplantable tumors, rabbits and normal dogs, and a dog with a spontaneous 
mammary carcinoma. Normal mice tolerated doses of 2-4 mg. while mice with tu- 



MANGANIELLO AND FIGGE— CANCER DETECTION AND THERAPY 7 

mors tolerate 2 total daily doses of 5-8 mg. Two dogs, one with spontaneous mam- 
mary carcinoma, were injected with 28 and 66 mg. without toxic symptoms. 

No ill effects of these injections were noted. Mice and the dog with malignant 
tumors concentrated some zinc 65 hematoporphyrin in the tumors, which became 
very red fluorescent. Most of the fluorescence appeared to be related to the presence 
of hematoporphyrin. The survey of the larger animals (rabbits and dogs) with a 
Geiger counter, revealed that the liver had 6-8 times as much radioactive zinc as 
the tumors. There was no fluorescence spectrum characteristic of zinc hematopor- 
phyrin. It was assumed that the liver had removed and had stored the zinc 65 
from the injected matter. It took about 9-12 months for the zinc 65 to leave the 
liver completely. 

On the basis of the above studies, eight human subjects with malignant neoplasms 
were injected with 10-100 mg. with no noticeable toxic effects. 

CONCLUSIONS 

1. Zinc porphyrin was not stable enough to be useful for cancer detection and 
therapy. The search for more stable metalloporphyrins is now in progress. 

2. A new method for preparation of metalloporphyrins is presented. 

BIBLIOGRAPHY 

1. Figge, F. H. J., Weiland, G. S., and Manganiello, L. O. J.: Cancer detection and therapy. 

Affinity of neoplastic, embryonic, and traumatized tissues for porphyrins and metalloporphy- 
rins. Proc. Soc. Exp. Biol, and Med., 68: 640-641: 1948. 

2. jFischer, H., Treibs, A., and Hummel, G. : Zur Kenntnis der naturlichen Porphyrine uber Hama- 

toporphyrin. Ztschr. f. physiol. Chem., 185: 33-73, 1929. 

3. Myer-Betz, F. : Untersuchungen uber die biologische Wirkung des Hamatoporphyrin und 

anderer Derivate des Blut und Gallenfarbstoffes. Deutsches Arch. f. klin. Med., 112: 476-503, 
1913. 



THE "LENTICULO-STRIATE ARTERY"*f 
ELINOR W. DEMAREST, M.D.,J 

The existence of the lenticulo-striate artery, Charcot's artery of cerebral hemor- 
rhage, as a definite entity has been seriously questioned. A survey of the original 
and current work on this artery reveals a general vagueness of terminology and 
an indefiniteness in the description of its course. From this, the 3 following questions 
arise: 1) Is there a constant lenticulo-striate artery, the so-called artery of cerebral 
hemorrhage of Charcot; 2) Are there proved cases of its rupture; 3) What is the 
status of this artery in the current textbooks? 

In 1868 Charcot (1) published a paper on his work on cerebral hemorrhage in 
which he reported 77 cases, 69 of which were hemorrhages at the base of the brain. 
The localization of the hemorrhage was not well defined nor was any attempt made 
to dissect out the involved vessels. Only 3 sites of rupture were found. This work 
constituted the foundation for his statement that cerebral hemorrhage occurs most 
frequently in the base of the external capsule anteriorly and then spreads through 
the lenticular nucleus to the internal capsule. He labelled the point of origin the 
"site of election" for cerebral hemorrhage. 

Charcot instigated Duret to investigate the arterial supply of the brain and the 
latter produced the first complete monograph on the subject in 1874 (2). The study 
of the distribution of the arteries to the corpus striatum was done by injecting the 
arteries, (no technique for this was given in the paper), and by then making two 
transverse sections through the brain. One was made "just a little behind the chiasm 
of the optic nerves." In this section he described the middle cerebral artery running 
over the perforated space for a distance of 1 centimeter and then disappearing be- 
hind the section of the posterior cerebral lobe, "in this interval it gives off of its su- 
perior border the arteries to the corpus striatum." Duret's description (translated) 
of these arteries was as follows: "One can divide these arteries into two groups. 
The external ones are very voluminous. The internal ones, situated near the vertex 
of the lenticular nucleus, are very small. Among the first group there is always one 
which goes for a certain distance along the base of the lenticular nucleus on the mar- 
gin of the external capsule in order to reach the caudate nucleus where it divides 
into four or five terminal branches which we find on the second section. It is this 
artery which, after our studies at Salpetriere and after the teaching of Charcot, lies 
in the location of predilection of hemorrhage of the corpus striatum. This arteriole 
supplies many collateral branches to the third segment of the lenticular nucleus. 
There are still two or three external branches which go in front of the third segment 
of the lenticular nucleus and finally reach the end of the corpus striatum. This group 
of external arteries are called the lenticulo-striate arteries." 

No dissection of these arteries was made for fear of rendering the structures 

* From the Department of Pathology, Division of Neuropathology, University of Maryland 
School of Medicine, Baltimore. 

t Received for publication September 1, 1949. 
J University Hospital, Baltimore. 



DEMAREST—THE LEX TICU LOST RI ATE ARTERY 9 

through which they passed unrecognizable. Duret makes no mention of the number 
of brains examined in making the above description. 

So Duret divided the basal branches of the middle cerebral artery into an external 
group, which he called the lenticulo-striate arteries, and an internal group, called 
the lenticulo-optic arteries. He described one of the former group as being constantly 
located in the area already designated by Charcot as the site of predilection for cere- 
bral hemorrhage. 

In the same year Heubner (3) published a paper on the circulation of the brain 
in which he did not name the basal branches of the middle cerebral artery. His work 
was done by injecting single arteries, piece by piece, and noting the part of the brain 
each piece supplied by sectioning the brain. He performed 60 injections on 30 brains. 
Heubner gave the location of origin of the arteries to the corpus striatum and de- 
scribed them as "those little arteries which supply the putamen and the middle part 
of the caudate nucleus and the external capsule." He made no attempt to differen- 
tiate or to name these arteries. He also contradicted many of Duret's other findings. 

Among Duret's comments on Heubner's work (4) was the statement that Heub- 
ner was too precise in his description of the origin of the arteries to the corpus stria- 
tum and that Heubner did not see the difference which existed between the internal 
and external (or lenticulo-striate) arteries. 

In his lectures of 1876-1880 (5), Charcot incorporates Duret's description of the 
lenticulo-striate arteries stressing the importance of one of them because of its size 
and predominant role in intra-encephalic hemorrhage. He states, "It appropriately 
could be called the artery of cerebral hemorrhage" and describes its course as enter- 
ing the third segment of the lenticular nucleus, then transversing the superior por- 
tion of the internal capsule and entering the body of the caudate ganglion. It then 
continued from behind, forward to the most anterior part of that ganglion. 

Kolisko (6), in 1891 introduced further corrections to Duret's work, mainly con- 
cerning the field of supply of the anterior choroidal artery. His work also was done 
by injection and section of the brain. No terminology is given to the basal branches 
of the middle cerebral artery. 

The area of supply of the middle cerebral artery differed in all of the above cited 
works. 

In 1909 Beevor (7) produced a survey of the maximum distribution of the major 
vessels based on the examination of 87 brains, but he paid little attention to the de- 
tails of distribution of the smaUer arteries. He injected simultaneously the major 
vessels, using four different colors. He showed variations in the areas supplied by 
each artery in the different brains. In coronal sections he thought that the curved 
arrangement of the area of the middle cerebral supply followed the course of the 
lenticulo-striate and lenticulo-optic arteries of Duret, but Beevor made no attempt 
to define or trace these vessels. He outlined more definitely the area of supply of the 
middle cerebral artery (8). 

Aitken (9), in 1909, published a series of figures of the arteries to the basal gan- 
glia based on actual dissection of the individual vessels, based on an examination of 
45 brains. He reproduced Duret's figure of the arteries to the corpus striatum and 
claimed that the caliber of Charcot's artery was greatly exaggerated. Figures were 



10 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

then given from textbooks of the day which had adopted Duret's findings. There 
is a gradual progress of the original error in the drawing until the so-called Charcot's 
artery is pictured lying practically in the external capsule for its entire length and 
arriving ultimately nowheres. Aitken suggested that this is the trend of the pic- 
torial future of this region if it is allowed to develop along the lines of credence. He 
denied the existence of any branches going to the optic thalamus, the lenticulo-optic 
arteries of Duret. 

Duret (10) defended his work against Aitken's criticisms by saying that his sec- 
tions are "demi-schematiques" because it was impossible to do otherwise, "since 
the arteries do not occupy only one position." This is in direct contradiction to his 
previous claim of constancy in the location of Charcot's artery in his original article 
(2). He claimed that Aitken reproduced the diagram, which accompanied Charcot's 
Lectures on Localization in Diseases of the Brain, and in which the volume of the 
artery of hemorrhage (Charcot's) was exaggerated and the drawing was schematic 
on the demand of Charcot, for the necessity of his demonstration. Duret concluded 
from the recent work done on the vascularization of the corpus striatum, that there 
are important variations in the origin and distribution of these arteries and in their 
courses. 

Ludlum (11), in 1909, was the first to cast skepticism upon the lenticulo-striate 
artery. His work also was done by injection. He found that the striate vessels varied 
in size from all very small ones in some brains to a fewer number and larger size in 
others, and that, in their path, no one arteriole seemed any larger than any other. 
He questioned the legitimacy of naming any artery the lenticulo-striate artery and 
calling it the artery of cerebral hemorrhage, "not withstanding Charcot." In all of 
93 cases of hemorrhage he could not find any artery sufficiently larger than another 
to be worthy of a name peculiar to itself. The hemorrhage and softenings were in 
different areas in each case. He demonstrated that the anatomy of the striate vessels 
is not always constant. He could not find any lenticulo-striate vessels coming up in 
the line of the external capsule, Charcot's area of predilection. He found that they 
arose more centrally in the lenticular nucleus and nourished the nucleus to this 
line of the external capsule. 

This was the first article in which the name lenticulo-striate was applied to any 
one artery and used synonymously with Charcot's artery of cerebral hemorrhage. 
Duret used the name lenticulo-striate to apply to a group of branches of the middle 
cerebral artery. Charcot's artery was one of this group. This is apparently one of the 
steps which has led to the present confusion in the description of the basal branches 
of the middle cerebral artery. 

Beginning in 1919, there was much investigation relating to the morphology of 
the corpus striatum and its blood supply. These authors have called the basal 
branches of the middle cerebral artery, the striate arteries, and have divided them 
into a mesial and lateral group, replacing the lenticulo-optic and lenticulo-striate 
groups of Duret. 

Elliot Smith (12) in 1919 commented on the constancy of the position and rela- 
tions of the lateral striate artery in every order of mammals. He found in the turtle's 
brain that there was given off from the middle cerebral artery, as it crossed the endo- 



DEM A REST—THE LENTICU LOST RI ATE ARTERY 11 

rhinal fissure, an exceptionally large perforating artery (or several arteries), which 
passed into the brain along the boundary line between the palaeostriatum and the 
hypopallium. He claimed that in mammals of every order, one or more large arteries 
entered the brain at the identical spot, that is, the postero-lateral corner of the tuber- 
osum olfactorium, immediately in front of the tubercle of the olfactory tract and 
to the inner side of the olfactory tract. "The artery that enters at this point in the 
human brain is the vessel which Charcot called the artery of cerebral hemorrhage." 
But as Elliot Smith describes his findings, he says one or more arteries enter at this 
point. So then, following his reasoning, there are one or more arteries which should 
be called the arteries of cerebral hemorrhage. 

In 1920 Shellshear (13) published his work done by injecting the middle cerebral 
artery. He referred to Duret as picturing the claustrum being supplied in part by 
"branches of the lateral striate artery." Duret, in the work sited by this article (2) 
makes no use of this name. 

We have thus progressed from Duret's "lenticulo-striate arteries," to Ludlum's 
"the lenticulo-striate artery," and now to Shellshear's "the lateral striate artery." 

Shellshear (13) described the middle cerebral artery as supplying antero-lateral 
branches which perforated the anterior perforated space. These branches further 
divided into the mesial and lateral striate arteries. 

Abbie summarized the above works (14, 15) and in 1937 (16) pointed out that 
clinicians, generally, accept and teach Duret's original findings with little or no 
appreciation of the corrections made since 1874. He stated that they still discuss 
the lenticulo-optic artery despite the fact that it has no existence. "The term len- 
ticulo-striate artery is still retained, although the name is misleading, implying some 
distinction between the lenticular nucleus and the corpus striatum, and has been 
replaced in anatomical teaching by the title, lateral striate arteries." He described 
the middle cerebral artery as giving rise to a number of large branches of different 
sizes which enter the brain just anterior to the attachment of the temporal lobe. 
Traced into the cerebral substance, these twigs are found to pass laterally and cau- 
dally between the claustrum and the basal mass, into the latter of which they sink at 
various intervals. "The largest of these was called the lenticulo-striate artery by 
Duret." In this statement Abbie makes the same mistake as did Ludlum. Abbie 
goes on to point out that the identification of any individual twig is impossible and 
in this paper these vessels are referred to collectively as the lateral striate arteries. 

In summary of the above works and in answer to the first question, the 
basal branches of the middle cerebral artery can be divided into an external and an 
internal group, the former being called the lenticulo-striate arteries after Duret. His 
name for the internal group, lenticulo-optic arteries, is omitted because the middle 
cerebral artery, as shown by Aitken (9), does not supply the optic thalamus. A bet- 
ter nomenclature is that offered by Abbie (16) in which the basal branches of the 
middle cerebral artery are called the striate arteries and are divided into a mesial 
and lateral striate group of branches. No worker, except Smith (12) who worked 
on mammalian brains, was able to confirm Duret's finding of an artery sufficiently 
distinctive or constant to be designated by a name, as the artery of cerebral hemor- 
rhage. 



12 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

Cases of Rupture 

In a search of the literature for reported cases of rupture of the lenticulo-striate 
arteries, only one case could be found. In 1831 Thompson (17) described an aneurysm 
or pouch "situated towards the cerebral aspect of the point of bifurcation of the 
anterior branch of the first fork of the middle cerebral artery" which had ruptured 
at a point away from the main vessel. Since this work was done before the time of 
Duret, one cannot be sure that his branch would fall within Duret's lenticulo-striate 
arteries. 

Shennon (18) in 1915 described multiple aneurysms occurring on the "smaller 
branchesof the lenticulo-striate artery." These were found in an "old formal-preserved 
brain" in which "the vessels were pulled out of the lacerated tissue surrounding the 
area of hemorrhage or were carefully dissected out." The site of the vessel rupture 
connected with the hemorrhage could be demonstrated. 

It is generally accepted that the most frequent site of intracerebral hemorrhage is 
in the region of the basal ganglia, although this was questioned by Ludlum (11). 
This area is supplied by both the anterior and middle cerebral arteries. Therefore; 
one is not justified in claiming rupture of the branches of the middle cerebral artery 
based on the location of the hemorrhage alone. It can be proved only by locating the 
site of rupture and by tracing the injured vessel back to its parent artery. 

The fact that hemorrhage starts in the anterior portion of the base of the external 
capsule, Charcot's site of predilection for cerebral hemorrhage, does not mean that 
the artery described by Duret (2) as located at this site has necessarily ruptured. 
As Abbie (16) showed, the lateral striate vessels are massed together between the 
putamen and claustrum, that is, at the base of the external capsule. So, for a short 
time, a large number of arteries of different sizes is concentrated within a very small 
volume of cerebral substance. Abbie concluded that the frequency of rupture at this 
point depends upon the law of probability rather than upon any inherent quality 
of the vessels in this situation. The number of arteries crowded within this small 
space is probably twice as great as that to be found in any comparable volume of 
cerebral tissue. This, Abbie said, is dependent upon the fact that the rhinal fissure, 
through which the majority of the lateral striate arteries enter the brain, has become 
doubled upon itself during human phylogeny. 

Hemorrhage can then occur from any one of this mass of lateral striate vessels 
at this site. There is no evidence that any one of these arteries is more susceptible 
to rupture or is more frequently found to be ruptured. The naming of one artery the 
artery of cerebral hemorrhage is not justifiable. 

Survey of Textbooks 

In a survey of thirty current textbooks of anatomy, neuroanatomy, and neurology, 
the arteries in question were found to be described as follows: 

1. Nine textbooks (19-27) describe Duret's original classification of lenticulo- 
striate and lenticulo-optic arteries, one of the lenticulo-striate arteries being called 
the artery of cerebral hemorrhage. Wilson (28) states that the existence of the len- 
ticulo-optic artery is denied and that of the lenticulo-striate is questioned. 



DEMAREST—THE LENTICU LOST MATE ARTERY 13 

2. Seven textbooks (29-35), reproduce Ludlum's use of the name lenticulo-striate 
to one artery and use it synonymously with the name artery of cerebral hemorrhage. 

3. Three textbooks (36-38) describe the branches of the middle cerebral artery 
as mesial and lateral striate arteries with the lenticulo-striate artery as a branch of 
the lateral striate. Lenticulo-striate artery is used synonymously with the artery of 
cerebral hemorrhage. 

4. One textbook (39) describes the branches of the middle cerebral artery as the 
mesial and lateral striate arteries with the artery of cerebral hemorrhage as a branch 
of the latter group. 

5. One textbook (40) introduces another nomenclature and calls the basal branches 
of the middle cerebral the Putamino-capsular branches. The term the artery of 
cerebral hemorrhage is not used. 

6. Two textbooks (41, 42) state that the artery of cerebral hemorrhage cannot be 
distinguished. The former reference uses the terms lenticulo-striate artery and artery 
of cerebral hemorrhage synonymously, denying the existence of both. 

7. Two textbooks (43, 44) state that since the secondary branches of the cerebral 
arteries vary considerably, they should not be distinguished by name. 

8. Four textbooks (45-48) make no reference to naming the basal branches of the 
middle cerebral artery. 

SUMMARY 

1. Duret's classification of the basal branches of the middle cerebral artery is 
given. He described a branch of the lenticulo-striate group as lying at the edge of 
the external capsule, and called this the artery of cerebral hemorrhage. 

2. No other worker examining human brains describes a distinguishably different 
artery located in this position. 

3. The use of the name lenticulo-striate artery and the artery of cerebral hemor- 
rhage as synonymous terms was introduced by Ludlum and is clearly a misquotation 
from Duret's work. 

4. Since only one case of proved or claimed rupture of the lenticulo-striate arteries 
is described in the literature, the name artery of cerebral hemorrhage is not justi- 
fiable. 

5. From the works studied, the basal branches of the middle cerebral artery can 
be divided into an external and an internal group, the former being named lenticulo- 
striate arteries after Duret. A preferable nomenclature is that of calling the basal 
branches the striate arteries. They may be divided into lateral and mesial groups. 

6. The current status of the nomenclature of the basal branches of the middle 
cerebral artery, based on a survey of thirty recent textbooks, is presented. It clearly 
shows the need for clarification and standardization of the naming of these arteries. 

BIBLIOGRAPHY 

1. Charcot, J. M., and Bouchard, C. : Nouvelles recherches sur la pathogenie de l'hemorrage 

cerebrale, Arch, de physiol. norm, et path., 1: 643, 1868. 

2. Duret, H.: Recherches anatomiques sur la circulation de l'encephale, Arch, de physiol., 1: 

73, 1874. 



14 BULLETIN OF THE SCHOOL OF MEDICINE, V. OF MD. 

3. Heubner, O.: Die luetische Erkrankung der Hirnarterien nebst allgemeinen Erarterungen zur 

normalen und path, histologic der arterien sowie zur Hirncirculation, Leipzig, 1874. 

4. Duret, H. : Recherches anatomiques sur la circulation de l'encephale, Arch, de physiol., 1: 

346, 1874. 

5. Charcot^ J. M.: Localisations dans les maladies du cerveau, 1876-1880, E. P. Fowler, trans., 

New York, Wm. Wood & Co., 70, 1878. 

6. Kolisko, A.: Uber die Bezerkung der Arteria choroidea ant. zum hinteren Schenkel der inneren 

Kapsel des Gehirns, 1891. 

7. Beevor, C. E.: On the distribution of the different arteries supplying the human brain, Phil. 

Trans. Roy. Society, 200: 1-55, 1909. 

8. Beevor, C. E.: Cerebral arterial supply, Brain, 30: 403-425, 1908. 

9. Aitken, H. F. : Report on circulation of the lobar ganglia, Boston Med. and Surg. Journal, 

CLX, 18 Supplement, May 6, 1909. 

10. Duret, H. : Revue critique de quelques recherches recentes sur la circulation cerebrale, En- 

cephale, 1: 7-27, 1910. 

11. Ludlum, S. D. W. : Distribution of encephalic hemorrhage, J. nerv. ment. dis., 36: 705, 1909. 

12. Smith, Elliot: Preliminary note on morphology of corpus striatum and origin of neopallium, 

Jour, of Anat., LIII, 1919. 

13. Shellshear, J. L.: Basal arteries of forebrain, J. Anat., London, LV, 27-35, 1920-21. 

14. Abbie, A. A.: Fore-brain arteries, Jour, of Anat., LXVII, 491, 1933. 

15. Abbie, A. A.: Morphology of fore-brain arteries, Jour, of Anat., LXVIII, 433, 1934. 

16. Abbie, A. A.: Anatomy of capsular vascular disease, Med. Jour, of Australia, 2: 564-568, 1937. 

17. Thompson, A.: Case of apoplexy, ensuing upon the rupture of a small aneurysm of a branch 

of the middle cerebral artery, Lond. M. and S. Jour., 7: 404-413, 1831. 

18. Shennon, E. M. J.: Miliary aneurysms in relation to cerebral hemorrhage, Edinburgh Med. 

Jour., 15: 245, 1915. 

19. Piersol: Human Anatomy, Philadelphia, Lippincott Co., 1207, 1930. 

20. Merritt: Fundamentals of Clinical Neurology, Toronto, Blakiston Co., 174, 1947. 

21. Nielsen, J. M.: Textbook of Clinical Neurology, New York, Paul B. Hoeber Inc., 284, 1941. 

22. Brain, W. R. : Diseases of Nervous System, London, Oxford Press, 290, 3rd Edition, 1948. 

23. Brock, S.: Basis of Clinical Neurology, New York, Wm. Wood & Co., 288, 1938. 

24. Jelliffe, S. E., and White, Wm. A.: Diseases of Nervous System, Philadelphia, Lea and Feb- 

iger, 739, 1935. 

25. Mettler: Neuroanatomy, St. Louis, C. V. Mosby Co., 165, 1948. 

26. Tilney and Riley: Form and Functions of the Central Nervous System, 2nd Edition, New 

York, Hoeber Inc., 723, 1923. 

27. Ptjrves-Stewart: Diagnosis of Nervous Diseases, 9th Edition, Baltimore, Wm. Wood & Co , 

94, 1945. 

28. Wilson, S. A. K.: Neurology, Vol. II, Baltimore, Williams & Wilkins, 1052, 1054,1066, 1075. 

1946. 

29. Bing and Haymaker: Textbook of Nervous Disease, 5th Ed., St. Louis, C. V. Mosby Co., 

438, 1939. 

30. Walshe, F. M. P.: Diseases of the Nervous System, 4th Ed., Williams & Wilkins, Balti- 

more, 99. 1945. 

31. Buzzard, E. F., and Greenfield, J. G. : Pathology of the Nervous System, London, Constable, 

117-119, 1921. 

32. Kuntz, A.: Textbook of Neuroanatomy, Philadelphia, Lea and Febiger, 3rd Ed., 1945. 

33. Looney, W. W. : Anatomy of the Brain and Spinal Cord, Philadelphia, F. A. Davis, 1932. 

34. Davis, C. L.: Laboratory Manual of Neuroanatomy, Baltimore, 44, 1945. 

35. Wechsler, I. S.: Textbook of Clinical Neurology, Philadelphia, Saunders Co., 343, 1947. 

36. Morris: Human Anatomy, 10th Ed., Philadelphia, Blakiston Co., 636, 1942. 

37. Muller: Applied Anatomy, Philadelphia, Lea and Febiger, 1938. 

38. Globus: Practical Neuroanatomy, Baltimore, Williams & Wilkins, 34, 1937. 

39. Cunningham: Textbook of Anatomy, 8th Ed., New York, Oxford Univ. Press, 1226, 1943. 



DEMAREST—TBE LENTICU LOST MATE ARTERY 15 

40. Grinker, R. R.: Neurology, 3rd Ed., Baltimore, Thomas Co., 573, 1943. 

41. Gray, H. : Anatomy of the Human Body, W. H. Lewis, Editor, 24th Ed., Philadelphia, Lea & 

Febiger, 571, 1942. 

42. Strong, O. S.: Human Neuroanatomy, Baltimore, Williams & Wilkins, 1943. 

43. Krieg, W. J. S.: Functional Neuroanatomy, Philadelphia, Blakiston Co., 367, 1942. 

44. Elliott, H. C: Textbook of the Nervous System, Philadelphia, Lippincott Co., 300, 1947. 

45. Ranson, S. A.: Anatomy of the Nervous System, 8th Ed., Philadelphia, Saunders Co., 1947. 

46. Weil: Textbook of Neuropatholog)', Philadelphia, Lea and Febiger, 1933. 

47. Cobb, S. : Preface to Nervous Disease, Baltimore, W. Wood & Co., 1936. 

48. Le Gros: Practical Anatomy, London, Arnold & Co., 1946. 



STUDIES IN THE TREATMENT OF TINEA CAPITIS. II 

Butyl 1-butanethiolsulfinate (Win 717) *f 

HARRY M. ROBINSON, M.D., HARRY M. ROBINSON, JR., M.D. and 
HARWOOD V. LINK, M.D. 

In the first study in this series (1) we presented the results of our clinical experience 
in the treatment of tinea capitis with 5-nitro-2 furfuryl methyl ether (Furaspor), and 
demonstrated that 42.47 per cent of the patients who used this drug in accordance 
with the directions given, received a good result. It is our plan to continue to investi- 
gate the therapeutic value of new preparations in the managements of microsporon 
audouini infection of the hair. The preparation under consideration in this presenta- 
tion is butyl 1-butanethiolsulfinate 1 (Win 717) which is a synthetic analog al allyl 
2-propene-l-thiolsulfinate, the antibacterial principle of allium sativum, the common 
garlic. 

NATURE OF DRUG 

Win 7 1 7 is a pale yellow oily substance which is slightly soluble in water and very 
soluble in most organic solvents. It is unstable in alkaline solutions and in the presence 
of strong reducing agents, but is stable in dilute acid solutions. The chemistry of this 
compound has been reported by Cavallito and his co-workers (2). Small, Bailey and 
Cavallito (3) have shown that a maximum dilution of 1:833,000 of this preparation 
will cause complete stasis of fungus growth. It was the opinion of these workers that 
this substance has an extremely high activity against microsporon audouini and also 
that it had the ability to penetrate the unbroken skin. They demonstrated in the 
patients they tested by patch tests that a 1 : 2500 solution was non-irritating to the 
skin. 

CLINICAL STUDIES 

The studies on this material were carried out in the Department of Dermatology 
of the University of Maryland School of Medicine. A total of 103 patients were 
started on treatment with this compound. Each child was proved to have tinea capitis 
by examination under the Wood's light, and following this smears and cultures on 
Saboraud's media were made. All cases treated with Win 717 were proved by culture 
to be infected with microsporon audouini. There were 53 white children and 50 Negro 
children in this study and the ages ranged from 2 to 14 years. Thirty-four of these 
children received treatment for less than 1 month primarily because of a lack of co- 
operation on the part of the parents who refused to bring them in to the clinic for 
medication and observation. The method of treatment was changed on any patient 
who did not show improvement after 6 months treatment with this drug. 

* From the Department of Dermatology, University of Maryland School of Medicine, 
t Received for publication May 2, 1950. 

1 The Butyl 1-butanethiolsulfinate (Win 717) used in this study was furnished by Wintbrop- 
Stearns, Inc. 

16 



ROBINSON, ROBINSON AND LINK— TINEA CAPITIS 



17 



METHOD OF TREATMENT 

As soon as the diagnosis was established the parent or guardian was instructed to 
shave the child's head once each week until the child was discharged as cured. Each 
patient was furnished with a two ounce bottle of Win 717 and instructed to rub this 
solution lightly into the scalp, with a toothbrush if possible, twice daily. In order to 
comply with health department regulations the same routine was followed as in the 
first section of this study, that is, the patient was instructed to wear a washable white 



TABLE 1 



AGE 
GROUP 


RACE 


SEX 


z 

o 

n 
w 
t* 

« en 
< z 

H W 

M a 

as H 

H < 

z 


RE- 
CEIVED 

LESS 
THAN 1 
MONTH 

OF 
TREAT- 
MENT 


Id 

« 


NUMBER 
OF FAIL- 
URES 
AFTER 6 
MONTHS 

OF 
TREAT- 
MENT 


IM- 
PROVED 
AFTER 6 
MONTHS 

OF 
TREAT- 
MENT 
BUT 
LOST 
FROM 
OBSER- 
VATION 


SHORTEST TIME 
TO PRODUCE 
IMPROVEMENT 


LONGEST TIME 

TO PRODUCE 

CURE 


SHORTEST TIME 

TO PRODUCE 

CURE 


NUM- 
BER OF 
UNCO- 
OPER- 
ATIVE 

PA- 
TIENTS 


1-5 


c 


M 
F 


21 

1 


9 



2 



5 
1 


1 



1 mon. 


12 mos. 


8 mos. 


10 


w 


M 

F 


10 
9 


1 
2 

7 
3 


1 

1 

4 



7 
2 

6 
1 



3 

1 



1 mon. 
1 mon. 


9 mos. 
9 mos. 


4 mos. 


1 

2 


6-10 


C 


M 

F 


21 
6 


3 mos. 


13 mos. 


8 
3 


VV 


M 
F 


27 
5 


9 

2 


5 
1 


6 
1 


1 



1 mon. 

2 mos. 


14 mos. 
10 mos. 


12 mos. 


5 
1 


11-14 


C 


M 
F 


1 



1 



1 












2 mos. 


12 mos. 






W 


M 
F 


2 







1 



16 


1 







1 mon. 


8 mos. 






Totals 


103 


34 


30 


6 


Average 1| 
months 


Average 10f 
months 


Average 8 
months 


31 



cap at all times so that there would be no interference with his or her school work. 
Each case was reported to the health department as an infectious disease. Parents 
were instructed to wash the child's scalp with soap and water twice each week. Fol- 
lowing the institution of treatment each child was examined under the Wood's light 
at bi-weekly intervals to determine improvement. 



RESULTS OF TREATMENT 



Of the 103 patients with tinea capitis as a result of microsporon audouini who were 
started on therapy with Win 717, 34 were treated for less than 1 month, and of these 
20 did not return after the initial clinic visit. There were 16 cures and 30 failures after 



18 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF AID. 

6 months of therapy. Six patients showed some improvement after 6 months of ther- 
apy but it was not considered sufficient to warrant continuation of the drug and, 
therefore, the method of treatment was changed. The shortest times to produce a 
cure was 4 months. The longest time to produce a cure was 14 months. The calcula- 
tion of the percentage of cures based on the total number of patients was 15.5 per 
cent; if, however, the number of patients who received less than 1 month of treat- 
ment is deducted then 23.1 per cent of the patients treated were cured. No patient 
was considered cured unless there was a complete absence of fluorescence under the 
Wood's light for at least 2 months after therapy had been discontinued. Thirty-one 
patients are listed as uncooperative and this may be explained on the basis of failing 
to shave the child's head or to apply the solution regularly. 

CONCLUSIONS 

1. Butyl 1-butanethiolsuffinate (Win 717) has been used in the treatment of 103 
patients with microsporon audouini infection of the hair. 

2. Thirty-four of these patients who were treated with this drug received less than 
1 month of therapy and 31 patients were uncooperative in attendance at the clinic 
and the method of treatment carried out by the parents. 

3. Of the total number treated, 15.5 per cent were cured; when the total number of 
patients who received less than 1 month of treatment is deducted, the percentage of 
cures is 23.1 per cent. 

4. The percentage of cures obtained with this drug in the treatment of tinea capitis 
in this clinic does not warrant its further use as a therapeutic agent in this disease. 

REFERENCES 

1. Robinson, H. M., Robinson, H. M., Jr. and Link, H. V.: Furaspor in the treatment of tinea 

capitis. Bull. School of Med. U. of M., 35: (July) 1950. 

2. Cavallito, C. J. and Bailey, J. H.: Allicin, the antibacterial principle of allium sativum. I. 

Isolation, physical properties and antibacterial action. Jour. Am. Chem. Soc, 66: 1950, 1944. 

3. Small, C. J., Bailey, J. H. and Buck, J. S.: The antibacterial principle of allium sativum. III. 

Its precursor and "essential oil of garlic." Jour. Am. Chem. Soc, 67: 1032, 1945. 



OSTEOGENIC SARCOMA ARISING IN PAGET'S DISEASE 
(OSTEITIS DEFORMANS) OF THE CALVARIUM 

Report or a Case Showing Cerebral Extension* 

ROBERT C. RODGER, M.D.,f RAYMOND K. THOMPSON, M.D.,J 
JOHN A. WAGNER, M.D.H 

Osteosarcoma may be expected to arise in 5 to 10 per cent of the cases of Paget's 
disease (osteitis deformans), especially in patients over 50 (1, 2, 3, 4). Summey and 
Pressly (5), in 1946 listed 76 cases of osteogenic sarcoma complicating Paget's disease. 
Of these 15 involved the calvarium. Since that time (26), additional cases (6, 7, 8, 9, 
13, 14, 15, 16, 17) have been reported with two arising in the skull (7, 8). Cerebral 
extension of an osteosarcoma arising in Paget's disease has been reported only 3 
times (8, 10, 11). Two additional cases (7, 12) showed subdural extension without in- 
vasion of the cerebral cortex. The following report represents the fourth case to show 
cortical invasion. 

REPORT OF A CASE 

A 52-year-old colored male mechanic was admitted to the U. S. Marine Hospital, Baltimore, Md., 
one month after sustaining a blow to the right parieto-occipital region. This episode was followed by 
headache, dizziness and the appearance of a mass at the site of injury. This mass gradually increased 
in size. Roentgen examination of the skull on admission to the hospital revealed an underlying rounded 
area of bone destruction in the right parieto-occipital region 2.5 cm. in diameter with a spongy ap- 
pearance of the surrounding, thickened calvarium. There was also mottling of the pelvis, 4th lumbar 
vertebral body, and left ulna. These findings were interpreted by the radiologist as suggesting Paget's 
disease of bone with a superimposed "metastatic lesion" in the right parietal area (Fig. 1). 

The physical examination disclosed a tender, fluctuant mass, 5x6 cm. in size, lying in the right 
occipital region. Neurologic and funduscopic examinations revealed no abnormalities. The patient's 
temperature, pulse and respirations were normal. An alkaline phosphatase was 44.5 Bodansky units, 
blood calcium 11.4 mgm. per cent; acid phosphatase 0.66 unit, and blood phosphorus 4.02 mgm. per 
cent. Serologic tests for syphilis were negative. Urinalysis and hematologic examinations showed no 
significant abnormalities. Serum proteins were within normal limits. The cerebro-spinal fluid was not 
examined. The scalp lesion was interpreted clinically as a hematoma. Surgical exploration revealed 
an apparently encapsulated mass overlying an irregular defect in the calvarium. A biopsy of the 
lesion was undertaken and the specimen was interpreted as showing Paget's disease (osteitis defor- 
mans) with a superimposed osteolytic form of osteogenic sarcoma. Subsequent exploration of an 
area of the ulna showed spongy thickening. This was interpreted microscopically as Paget's disease. 

A block excision of the tumor, including the adjacent uninvolved calvarium was then performed. 
The dura was incised around all except the vertex attachment of the falx, adjacent to the superior 
saggital sinus. The tumor was then rolled out of its nest in the brain. A small fragment was found 
attached to the superior parietal region of the cortex. This was removed and bleeding controlled with 
an electrocautery. It was necessary to transect the tumor at the periphery so that complete excision 
was not possible. A tantalum plate was used to fill the defect and skin grafting was subsequently 

* From the Pathology Service and Tumor Clinic, U. S. Marine Hospital, Baltimore, Md. Received 
for publication July 15, 1950. 

f Senior Assistant Surgeon, USPHS; Resident in Pathology, U. S. Marine Hospital, Baltimore, 
Md. 

X Consultant in Neurologic Surgery, U. S. Marine Hospital, Baltimore, Md. 

H Consultant in Neuropathology, U. S. Marine Hospital, Baltimore, Md. 

19 



20 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

undertaken. A microscopic examination confirmed the diagnosis of osteogenic sarcoma complicating 
Paget's disease of the skull and showed neoplastic cells within the dura and leptomeninges. 

Five months later a recurrent nodule was seen in the scalp. This was resistant to local roentgen 
therapy totaling 2050 roentgen units. Nine amonths after operation the patient was readmitted to 
the hospital with severe headache and, shortly thereafter, suffered a generalized convulsion which 
began in the right hand. Following this attack he became stuporous. He continued to complain of 
severe frontal headache, and gradually became more and more disoriented. A daily rise in temperature 
to 100°F. with a terminal elevation to 102° was recorded. Objective neurologic findings were absent 
and there was no evidence of weakness of the extremities. Terminally, he became comatose and died 
nine and one-half months after the operation. 




Fig. 1. Coronal section of brain just caudal to the splenium of the corpus callosum, showing 
cortical invasion by tumor with extensive secondary hemorrhage. 

Autopsy findings. An examination of the body generally showed only pulmonary congestion. The 
contour of the cranium was irregular. A necrotic, ulcerating, fungating mass was seen at the vertex 
and in the right parieto-occipital region. The scalp was firmly adherent to the thickened calvarium. 
Large neoplastic masses involving the right parietal and occipital bones invaded the underlying dura 
mater and falx cerebri. On dissection following fixation, the dural mass was seen to be invading the 
cerebral cortex which it had infiltrated and destroyed at a point 5 cm. rostrad to the right occipital 
pole and 2 cm. from the midline (Fig. 1). The greatest diameter of the invading nodule was 1 cm. It 
was continuous with an extensive area of intracerebral hemorrhage extending through the right 
centrum ovale, rostrad to the level of the cerebral peduncles. Here it involved the basal ganglia on 
the right with intraventricular extension and displacement of the midline structures toward the left. 

A microscopic examination of the calvarium revealed areas of trabecular thickening with fibrosis 
of marrow spaces (fig. 3) alternating with areas of infiltration by pleomorphic, occasionally multinu- 
cleated, neoplastic cells forming irregular osteoid deposits and, simultaneously, resulting in osteolysis 



RODGER ET A L — OSTEOGENIC SARCOMA IN PAGET'S DISEASE 21 




Fig. 2 (Top). Roentgenogram of skull showing mottled thickening of calvarium and punched-out 
area in parietal region. 

Fig. 3 (Bottom). Bone from skull showing thickened trabeculae and fibrous marrow of Paget's 
disease. Van Gieson stain. X 170. 



22 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 




i ■'■■ r-~' ;?•-!';■ 'A'.'; -;v.7 ' ■. - 






w 



^ 



w 






*' 











Fig. 4 (Top). Osteogenic sarcoma in leptomeninges, right parietal lobe. Romanowsky stain. X 
170. 

Fig. 5 (Bottom). Osteogenic sarcoma invading cerebral cortex, right parietal lobe. Romanow- 
sky stain. X 340. 



RODGER ET A L— OSTEOGENIC SARCOMA IN PAGET'S DISEASE 23 

of existing trabeculae. Neoplastic cells similar to those seen in the biopsy made up the dural masses 
and the nodule infiltrating cortical tissue (figs. 4 and 5). A moderately intense zone of reactive glia 
surrounded the invading cells. There was also a mild lobular pneumonia. Changes consistent with 
Paget's disease were found in the left ulna and pelvis. 

COMMENT 

The report within 7 years of 6 cases of osteosarcoma arising in Paget's disease of 
the skull and showing subdural extension, has led to the inclusion of a new entity of 
increasing frequency among secondary intracranial neoplasms. These cases have 
demonstrated that, following involvement of the inner table of the skull, the dura can 
promptly be invaded and intracranial extension may occur, the arachnoidal mem- 
branes constituting little or no barrier. 

In this brief series, certain features have been repeated. Two of the cases have 
shown an osteolytic form of sarcoma. Each has also shown secondary massive intra- 
cerebral hemorrhage. 

SUMMARY 

A case of osteogenic sarcoma (osteolytic type), arising in Paget's disease (osteitis 
deformans) of the calvarium, with intracerebral extension is presented and the litera- 
ture reviewed. This case represents the sixth to show subdural extension and the 
fourth to show cerebral involvement. Massive intracerebral hemorrhage was a ter- 
minal feature of the process. 

REFERENCES 

1. Willis, R. A.: Pathology of Tumors. C. V. Mosby Co., St. Louis, Mo., 1948. 

2. Geshickter, C. F. and Copeland, M. : Tumors of Bone. N. Y., 1936. 

3. Bird, C. E.: Sarcoma complicating Paget's disease of bone. Arch. Surg., 14: 1187-1208 (June) 

1927. 

4. Kerr, J. W.: Osteitis deformans. Public Health Bulletin No. 209, U. S. Government Printing 

Office (Sept.) 1933. 

5. Summey, T. J. and Pressly, C. L. : Sarcoma complicating Paget's disease of bone. Ann. Surg., 

123: 135-154 (Jan.) 1946. 

6. Platt, H.: Sarcoma in abnormal bones. Brit. J. Surg., 34: 232-239 (Jan.) 1947. 

7. Warren, S. and Agar, D. F.: Paget's disease of the skull with osteogenic sarcoma (Tumor 

Seminar). J. Mo. State M. Assoc, 45: 348-349 (May) 1948. 

8. Russell, D. S.: Malignant osteoclasoma. J. Bone and Joint Surg. 31-B: 281-290 (May) 1949. 

9. Sear, H. R.: Osteogenic sarcoma as a complication of osteitis deformans. Brit. J. Radiol., 22: 

580-587 (Oct.) 1949. 

10. Kirschbatjm, J. D.: Fibrosarcoma of the skull in Paget's disease. Arch. Path., 36: 74-79 (July) 

1943. 

11. Manganiello, L. O. J., Reimann, D. L. and Wagner, J. A.: Cerebral involvement by osteo- 

genic sarcoma associated with Paget's disease of the skull. Arch. Neur. and Psych., 59: 99-106 
(Jan.) 1948. 

12. Wolfe, A. M. and Black, W. C: Paget's disease; report of case with intracranial neoplasm. 

Rocky Mount. M. J., 37: 586-587 (Aug.) 1940. 

13. Layani, F. and Olivier, C: Osteosarcoma and Paget's disease. Presse Med., 54: 145-146 

(Mar. 1946). 

14. Pique, J. A., Tamini, R. A. and Serebinsky, F.: Osteitis deformans, sarcomatous transforma- 

tions. Bol. y trab. Soc. argent, de cirujanos, 7: 138-149 (1946). 

15. Schajowicz and Alarcon, F. O.: Osteitis deformans, sarcomatous transformation. Rev. ortop. 

y traumatol., 15: 233-246 (Apr.) 1946. 

16. Betoulleres, P., Romien, C. and Guilbert, H. L.: La degenerescence maligni de la maladie 

osseuse de Paget. Bull. Assoc, franc, l'etude cancer, 35: 47-64, 1948. 

17. de Seze, S. and Lefebure: Sarcome et maladie de Paget; deux observations. Rev. du rhum., 14: 

126-128 (Apr.) 1947. 



PERICARDIAL COELOMIC CYSTS* 
Review of the Literature and Report of a Case 

WILLIAM RIENHOFF, Jr., M.D. F.A.C.S., ROBERT L. JACKSON, M.D. F.A.C.S. 
and MARCUS W. MOORE, Sr., M.D. 

Baltimore, Maryland 

Six cases of Coelomic Cysts of the Pericardium were reported by Lambert (1) in 
1940, in which 2 anterior pericardial cysts were removed by Berry. Blades later re- 
classified 5 cases of anterior mediastinal tumors as Coelomic Pericardial Cysts. In 
1947, Leahy and Culver (2) reviewed the literature of cases of pericardial cysts. 
Bradford, Mahon, and Grow (3), in the same year reported a series of 8 cases. Other 
case reports have been made by Lam (4), Leahy and Culver (2), and Buyers and 
Emery (5). 

Thompson (6) states that according to the suggestion of Freedlander and Gebauer 
(7), the pericardial defects might be produced by failure of fusion of embryonic trans- 
verse septum with the pleuro-pericardial or pleuro-peritoneal membranes. However, 
Lambert (1) attributes the origin of pericardial cysts to failure of primitive mesen- 
chymal lacunae, which form the pericardium, to fuse with others, and instead to 
form independent cavities. He describes these cysts as being lined by vascular en- 
dothelial cells upon a loose fibrous tissue containing capillaries and noted that it 
was difficult to distinguish between mesothelial and endothelial linings. 

Coelomic pericardial cysts have no distinct characteristic features which differen- 
tiate them from other mediastinal cysts (6). Coelomic pericardial cysts usually give 
a rounded defined translucent mass roentgenologically. Buyers and Emery (5) states 
that the diagnosis is made only from gross and pathologic findings. 

Mediastinal cysts in former years were felt to be rare in occurrence. However, 
with recent advances in thoracic surgery, many of these cysts have been success- 
fully removed. In 1945 Laipply (8) gave an extensive review of mediastinal cysts 
and classified them according to their histologic structure. 

case report 

H. J., a Negro male, 44 years of age was admitted to Provident Hospital on September 6, 1949. 
The patient had been asymptomatic but the presence of an anterior mediastinal tumor was dis- 
covered in May 1949 during a routine public health chest roentgenologic examination. There was 
no history of chest pains, hemoptysis, shortness of breath, or palpitation. There had been no weight 
loss, fever, or wheezing. 

The patient was a slender male, in no acute distress, lying flat in bed, cooperative and well- 
oriented. His temperature was 98 F.; his pulse rate was 80 per minute; his respiratory rate was 20 
per minute; and his blood pressure was 120 mm. Hg systolic and 80 mm. Hg diastolic. The only 
abnormal physical finding was an area of increased dullness over the apex of the heart that extended 
from the left parasternal line to the left anterior axillary line. 

Roentgenographs revealed a small tumor at the apex of the heart in the left anterior mediastinum 

* From the Surgical Service of Dr. Samuel McLanahan, Provident Hospital. Baltimore, Mary- 
land. 

Received for publication September 1, 1950. 

24 



RIENHOFF ET AL— PERICARDIAL COELOMIC CYSTS 



25 




Fig. 1 Fig. 2 

Fig. 1 . A preoperative roentgenograph showing a translucent tumor of the left cardiophrenic angle 
Fig. 2. A postoperative roentgenograph showing that the pericardial coelomic cyst was. removed 




DtAPHRAGM' 



Fig. 3. A large unilocular thin walled pericardial cyst was found at operation 



26 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

(Figure 1). This tumor was ovoid, smooth, circumscribed, and translucent. It measured 8x7x5 
cm. Fluoroscopy revealed no pulsation in the tumor. It was found to spring from the pericardium 
and not to be connected to the heart. Its base was on the left leaf of the diaphragm. The motility 
of the diaphragm was normal. The hemoglobin was 94 per cent and the leukocytes numbered 1 1 ,000 
per cubic millimeter. The erythrocytes count was 4,730,000 per cubic millimeter. The blood Was- 
sermann test for syphilis was negative. The urinalysis and electrocardiagraph were normal. 

In May, 1949 an exploratory thoracotomy was advised, to which he consented in September 
1949. Serial roentgenographs between the 4 month period revealed no change in the size or position 
of the tumor. 

The operation was performed September 8, 1949, under intratracheal nitrous oxide and oxygen 
and intravenous sodium pentothal and curare. A left anterio-lateral incision was made in the eighth 
intercostal space 18 cm. long, and the ribs were forcibly retracted with a rib spreader. The left lung 
was retracted laterally. A large unilocular thin walled cyst was found in the anterior mediastinum. 
It measured 10 x 12 x 6 cm. The phrenic nerve was overlying the lateral border of the cyst (Fig- 
ure 3). 

The cyst was enulceated by blunt dissection. Hemorrhage was slight and easily controlled. The 
phrenic nerve was not divided. Closure was effected with interrupted number 2 chromic catgut 
sutures. The post-operative condition of the patient was excellent. Temperature, pulse, and respir- 
atory rates were normal throughout the entire post-operative course. The skin sutures were re- 
moved and the patient was discharged in excellent condition on the seventh post-operative day. 
Recent roentgenographs revealed a good expansion of the lungs with no evidence of recurrence of 
the cyst (Figure 2). To date he has remained in excellent health. 

Pathologic Examination 

The specimen consisted of a whitish smooth walled unilocular cyst with a clear watery fluid, having 
a specific gravity of 1,001. It measured 10 x 12 x 6 cm. The wall was thin and translucent. The 
inner surface was smooth, glistening and traversed by thread-line blood vessels. 

Microscopically the cyst wall consisted of a single layer of flattened mesothelial type cells on a 
thin layer of vascularized loose connective tissue. The pathologic diagnosis was pericardial coelomic 
cyst. 

DISCUSSION 

Following the classifications derived by Laipply (8) and by Donald (9) this cyst 
was identified as a pericardial coelomic cyst. It had the gross appearance of the 
smooth thin walled translucent pericardial cyst and had the pathologic evidence of 
a single layer of mesothelial cells on a thin connective tissue stroma. The cyst found 
in this case report could be differentiated from other congenital mediastinal cysts. 
The gastroenteric cyst was ruled out by the absence of smooth muscle fibers, mucous 
glands and columnar epithelium. In the dermoid and teratoid cysts, hair, bone, skin 
and cartilage can usually be identified. Also, the congenital bronchial cyst could be 
ruled out by the absence of walls with smooth muscle, mucus glands, cartilage and 
ciliated epithelium. 

SUMMARY 

A case of coelomic cyst of the pericardium discovered during a mass roentgenologic 
survey is reported. Surgical excision of the cyst was successful with no recurrence. 

REFERENCES 

1. Lambert, A. V. S.: Etiology of thin walled thoracic cysts, J. Thoracic Surg. 10: 1, 1940. 

2. Leahy, L. J., and Culver, G. J.: Pericardial coelomic cysts, J. Thoracic Surg. 16: 695, 1947. 



RIENHOFF ET AL— PERICARDIAL COELOMIC CYSTS 27 

3. Bradford, M. L., Mahon, H. W., and Grow, J. B.: Mediastinal cysts and tumors, Surg., Gynec. 

& Obst. 85: 470, 1947. 

4. Lam, C. R.: Pericardial coelomic cysts, Radiology 48: 239, 1947. • 

5. Byers, R. A., and Emery, F. B.: Pericardial coelomic cysts, Arch. Surg. 60: 1002, 1950. 

6. Thompson, J. V.: Mediastinal tumors and cysts, Internat. Abstr. Surg. 84: 211, 1947. 

7. Freedlander, S. O., and Gebauer, P. W. : Diseases of aberrant intrathoracic lung tissue, J. 

Thoracic Surg. 8: 581, 1939. 

8. Laipply, T. C: Cysts and cystic tumors of the mediastinum, Arch. Path. 39: 153, 1945. 

9. Donald, C. J., Jr.: Mediastinal cysts, South. Surgeon 13: 148, 1947. 



DEPARTMENT OF OBSTETRICS 

Statistical Summary 

July 1, 1949 through June 30, 1950 



1. Number of patients discharged 

2. Number of patients delivered and discharged 
(twins 33 sets) 

a. Patients delivered of viable infants 

b. Patients aborting 

3. Maternal mortality 

a. Rate per 1000 live births 

4. Number of viable babbies born (400 gms. 
and over) 

a. Term 

b. Premature* 

A. Number born alive 

a. Term 

b. Premature 

B. Number still born 

a. Term 

b. Premature 

c. Rate per 1000 viable births 

5. Number of neonatal deaths 

a. Term 

b. Premature 

c. Rate per 1000 viable births 

6. Total fetal mortality 

a. Rate per 1000 births 



TOTAL 


HOME 


HOSPITAL SERVICE 




Wh. 


Col. 


Wh. 


Col. 


3586 


11 


490 


523 


1565 


3292 


11 


490 


474 


1413 


3241 


11 


486 


469 


1399 


51 





4 


5 


14 


1 











1 


0.3C 











0.71 


3274 


11 


490 


474 


1419 


2906 


10 


446 


424 


1208 


368 


1 


44 


50 


211 


3201 


11 


479 


468 


1381 


2872 


10 


441 


421 


1193 


329 


1 


38 


47 


188 


73 





11 


6 


38 


34 





5 


3 


15 


39 





6 


3 


23 


22.3 


00.0 


22.4 


12.7 


26.8 


50 


1 


10 


6 


25 


19 


1 


4 


1 


8 


31 





6 


5 


17 


15.2 


90.9 


20.4 


12.7 


17.6 


123 


1 


21 


12 


63 


37.5 


90.9 


42.8 


25.4 


44.4 



997 

904 
876 

28 





818 
62 
862 
807 
55 
18 
11 

7 
20.4 

8 

5 

3 

9.1 
26 
29.5 



A premature baby is one which weighs less than 2500 gms. at birth. 

Patient Status 



Private patients (twins 4 sets) 

White — registered clinic (twins 5 sets) .... 
White — nonregislered clinic (twins sets) 

Colored — registered (twins 18 sets) 

Colored — nonregistered (twins 6 sets) .... 



LIVE BIRTHS STILLBIRTHS ABORTION 



862 

392 

87 

1668 

192 



18 

2 

4 

31 

18 



28 

2 

3 

8 

10 



908 

396 

94 

1707 

220 



3291 



73 



51 



3325 



Presentation: Premature and Full Term (Delivery Diagnosis) 





SPON. 


DEL. 


SPOX. 


DEL. 


OPERATION 


OPERATION' 


TOTAL 




HOME 


HOSP. 


FROM BELOW 


FROM ABOVE 




Wh. 


Col. 


Wh. 


Col. 


Wh. 


Col. 


Wh. 


Cot. 


Wh. 


Col. 


Vertex 


10 


480 


276 


606 


980 


664 


32 


64 


1298 


1814 


Face 











2 


4 


2 


1 





5 


4 


Brow 

















1 





1 





2 


Breech 


1 


8 


3 


10 


46 


47 


8 


4 


58 


69 


Transverse 











1 


1 


4 


2 


4 


3 


9 


Compound 





2 





2 


2 


4 








2 


8 


Unknown 











3 

















3 




















1366 


1909 



28 



DEPARTMENT OF OBSTETRICS— A NN I AL REPORT 



29 



Types of Delivery 



1. Spontaneous. 

2. Operative . . . 



H 



Forceps — total . . 

Indications 

Control 

Presentation occiput posterior. 

Delivered as such 

Following forceps rotation. . . 

Following manual rotation. . . 
Presentation occiput transverse . 

Following forceps rotation . . . 

Following manual rotation. . . 

As such 

Presentation, face 

Labor, prolonged 

Heart disease . . 

Cord — prolapse of 

Contracted pelvis 

Fetal distress 

Brow 

Compound 

Toxemia 

Inertia 



-total . 



1542 

1264 

94 

26 

49 

19 

99 

61 

37 

1 

4 

57 

6 

1 

13 



1 

3 







116 

13 

29 

2 

25 

2 

37 

34 

3 



2 

22 



1 

7 

1 





2 

2 



total 



Breech extraction 

Frank breech 

a. Decomposed 

Full breech 

Primigravida 

Multigravida 

Head-Af tercoming-f orceps to 

C. Version — internal podalic and breech extraction 
Indications 

Presentation transverse 

Second twin 

D. Craniotomy 

E. Other Destructive operations — total 

Indications and types transverse lie, decapitation. . . 

F. Laparotomy (other than cesarean section) — total. . . 
Indications and type exploratory, — volvulus, cecum. 

G. Cesearean section — all types — total 



Wh. 



165 
320 



286 

216 

19 

6 

11 

2 

22 

14 

8 



2 

21 

4 



1 





1 





21 

13 

3 

8 

7 
14 
17 







1 
1 
1 
1 

12 



Col. 



1103 
806 



671 

511 

47 

13 

23 

11 

46 

31 

15 



2 

46 



2 

9 

1 

1 

2 

2 

2 

60 
30 

2 
30 
32 
28 
21 

4 

3 
1 





71 



124 
756 



701 

550 

57 

9 

40 



50 

17 
1 
2 

12 
2 


10 






24 
15 

2 

9 

9 
15 










30 



1392 

1882 



1658 

1277 

123 

28 

64 

21 

136 

95 

40 

1 

6 

79 
6 
1 
20 
1 
1 
3 
2 
2 

105 

58 

7 
47 
48 
57 
46 

4 

3 
1 

1 
1 
1 
1 
114 



42.7 
57.3 



50.6 



3.2 



0.1 



30 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



Type of Delivery — Continued 



Indications 

1 . Pelvis contracted. 

2. Baby — excessive 
size of 

3. Inertia uterine . . . 

4. Malpresentation . . 

5. Placenta previa. . . 

Centralis 

Partialis 

Marginalis 

6. Placenta — prema- 
ture separation of 

Complete 

Partial 

7. Preeclampsia 

8. Eclampsia 

9. Section previous. . 

a. Toxemia 

b. Malpresenta- 
tation 

c. Plac. compl. . . . 

d. Unknown 

10. Presentation 
breech 

11. Rh incompata- 

bility 

12. Prolapse cord 

13. Medical disease. . . 

14. Diabetes 



CLASS 


LAPARO 
TRACH 


EXTRA 
PERITO. 


P.M. 
CESAR. 


CESAR. 
HYSTER. 


SERVICE 


PVT. 


TOTAL 


Wh. 


Col. 


4 


84 


23 


1 


2 


12 


71 


31 


114 





45 


15 


1 





5 


45 


11 


61 








1 











1 





1 





5 


3 











6 


2 


8 





1 








2 





2 


1 


3 


1 


7 











1 


2 


5 


8 


1 


3 

















4 


4 





3 


o 








1 


2 





3 





1 

















1 


1 


2 


3 














2 


3 


5 


2 


1 














1 


2 


3 





2 














1 


1 


2 





3 


3 








2 


4 





6 





1 














1 





1 


1 


11 














4 


8 


12 





3 














2 


1 


3 


1 


3 

















4 


4 





1 

















1 


1 





4 














2 


2 


4 





1 














1 





1 





3 











3 








3 





1 














1 





1 








1 











1 





1 





3 











1 


1 


1 


3 



53.5 

7.0 
7.0 

4.5 

6.1 
10.5 



9 



DEPARTMENT OF OBSTETRICS— ANNUAL REPORT 



31 



Other Operations and Procedures not Including Delivery 



1. Episiotomy — total 

a. Central 

With rectal laceration 

b. Paramedian 

with rectal laceration 

2. Perineorrhaphy — total 

a. Indicated (laceration) 

b. Elective (old R.V.O.) . . 

3. Trachelorrhaphy 

4. Hysterostomatomy — total 

a. Dystocia cervical: forecoming head 

5 . Hysterectomy — total 

a. For sterilization only 

b. Infection 

6. Dilatation and curettage— total 

a. Secundines retained 

b. Mole, hydatidiform 

c. Not pregnant 

7. Placenta, manual removal of — total 

8. Hematoma, evacuation of 

9. Fetal scalp clamp — application of — total . . 

a. Placenta — premature separation of ... . 

b. Inertia uterine 

c. Toxemia 

d. Other .-,.-.. 

10. Amniorrhexis for induction of labor — total. 

a. Preeclampsia 

b. Hypertensive disease 

c. Hydramnios 

d. Placenta — -premature separation of ... . 

e. Convenience 

11. Sterilization 

a. Section previous 

b. Multiparity (para 8 or more) 

c. Hypertensive disease 

d. Diabetes 

e. Pathology cardiac 

f . Psychiatric 

g. Sickle cell anemia 

h. Other 

Accompanying Section 

12. Replacement of cord 

13. Appendicectomy 

14. Other gyn. operations 

15. Other operations 



SERVICE 








PVT. 


TOTAL 


Wh. 


Col. 


287 


732 


765 


1784 


283 


708 


721 


1712 


14 


22 


39 


75 


4 


24 


44 


72 














49 


136 


61 


246 


33 


101 


53 


187 


16 


35 


8 


59 


8 


32 


29 


67 





5 


4 


9 





5 


4 


9 





3 





3 





2 





2 





1 





1 


3 


1 


14 


18 


1 


1 


14 


16 


1 








1 


1 





1 


1 


10 


10 


30 


50 





1 


1 


2 


4 


12 


3 


19 


2 





3 


5 


1 


8 





9 





2 





2 


1 


2 





3 


5 


14 


16 


35 


3 


11 


4 


18 








1 


1 








1 


1 


1 


2 


3 


6 


1 


1 


7 


9 


13 


77 


7 


97 





10 


4 


14 


5 


55 





60 


2 


7 


1 


10 


1 








1 


2 


2 





4 


3 


2 





5 





1 





1 








2 


2 


1 


8 


3 


12 





1 





1 


8 


17 





25 





2 


1 


3 





1 


3 


4 



% 



54.5 
2.3 



1.5 



1.1 



2.9 



32 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



Other Operations and Procedures not Including Delivery — Continued 



ABORTIONS— Total 

Therapeutic — total 

a. Rupture, marginal sinus 

b. Preeclampsia 

Spontaneous — total 

a. Syphilis-maternal 

b. Hypothyroidism 

c. Etiology undetermined 
Requiring completion 



SERVICE 








Wh. 


Col. 


PVT. 


TOTAL 


5 


18 


28 


51 





1 


1 


2 





1 





1 








1 


1 


5 


17 


27 


49 





1 





1 








1 


1 


5 


16 


26 


47 


1 


1 


14 


16 



Complications 



Maternal 

Placental — total 

Placenta previa centralis 

Placenta previa partialis 

Placenta previa marginalis 

Placenta, premature separation of 

Placenta retained 

Cord, prolapse of 

Pelvis contraction of (X-ray classification) 

Contracted inlet 

Contracted midplane 

Contracted outlet 

Contracted inlet and outlet 

Contracted inlet and midplane 

Contracted midplane and outlet 

Contracted inlet, mp and outlet 

Contracted asymmetrical 

Labor 

Prolonged 

Shock antepartum 

Intrapartum 

Postpartum 

Uterus — inertia of 

Rupture of 

Inversion of 

Membranes — rupture of — premature . . . 

Dystocia — cervical 

Hemorrhage and blood dyscrasia 

Anemia 



Wh. 



361 

22 

1 


7 

12 
2 

21 
4 
5 
2 

5 
4 
1 


45 
8 
1 
1 

15 
8 

1 

11 



154 

42 



Col. 



1568 

60 

1 

3 

1 

29 

18 

8 

154 

58 

11 

7 

6 

38 

14 

19 

1 

216 

74 



6 

27 

32 

1 

1 

72 

3 

565 

369 



PVT. 


TOTAL 


610 


2539 


62 


144 


5 


6 





4 





1 


25 


61 


30 


60 


2 


12 


41 


216 


9 


71 


14 


30 


3 


12 





6 


2 


45 


9 


27 


4 


24 





1 


86 


347 


27 


109 





1 


5 


12 


9 


51 


17 


57 





1 





2 


26 


109 


2 


5 


221 


940 


23 


434 



DEPARTMENT OF OBSTETRICS— ANNUAL REPORT 



33 



Complications — Continued 



Maternal — Continued 

Hemorrhage and blood dyscrasia — Continued 

Sickle cell anemia 

Hemorrhage antepartum 

Intrapartum 

Postpartum 

Rh negative — total 

With antibodies 

Other iso immunization 

Cardiovascular disease 

Toxemia 

Hypertensive disease 

Preeclampsia 

Eclampsia 

Unclassified 

Infection 

Genital tract 

Puerperal 

Wound — perineal 

Intrapartum infection 

Respiratory 

Tuberculosis active 

Tuberculosis arrested 

Respiratory disease, other 

Urinary tract 

Pyelitis — antepartum 

Pyelitis — postpartum 

Infection miscellaneous 

Thrombophlebitis 

Appendicitis. 

Hydxamnios 

Mole hydatidiform 

Diabetes 

Shoulder dystocia 

Hypothyroidism 

Hyperthyroidism 

Hyperemesis 

Epilepsy 

Rectum — stricture of 

Ovarian Cyst 

Fibroids 

Fetal 

Injury and disease 

Hemorrhage intracranial 

Atelectasis 



SERVICE 








pvr. 


TOTAL 


Wh. 


Col. 





3 





3 


4 


8 


9 


21 


7 


29 


25 


61 


24 


45 


14 


83 


76 


110 


150 


336 


11 


13 


5 


29 


1 


1 





2 


12 


31 


12 


55 


50 


297 


56 


403 


17 


92 


20 


129 


32 


199 


35 


266 


1 


5 





6 




42 


1 

172 


1 

72 


2 
286 


19 


112 


27 


158 


14 


75 


23 


112 


3 


4 


2 


9 


2 


33 


2 


37 


12 


26 


23 


61 


3 


10 


3 


16 


2 


6 


3 


11 


7 


10 


17 


34 


10 


33 


22 


65 


6 


21 


14 


41 


4 


12 


8 


24 


1 


1 





2 





1 





1 


1 








1 


6 


30 


2 


38 


1 





1 


2 


4 


7 


6 


17 


3 


9 


3 


15 





4 


18 


22 





4 


2 


6 





1 


8 


9 





1 





1 





6 


1 


7 


. 1 


1 


2 


4 





10 


17 


27 


61 


174 


90 


325 


20 


44 


26 


90 


4 


10 


5 


19 


8 


24 


16 


48 



34 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



Complications — Continued 



Fetal — Continued 

Injury and disease — Continued 

Newborn — hemolytic disease of 

Other injury 

Infection 

Diarrhea 

Conjunctiva's 

Impetigo 

Pneumonia 

Omphalitis 

Septicemia 

Syphilis 

Development — abnormalities of. . 

CNS 

Heart 

Gastrointestinal 

Extremities 

Mouth 

Other 

Hemorrhagic disease 

CNS anoxia 

Tumors 

Others 



SERVICE 








PVT. 


TOTAL 


Wh. 


Col. 


6 


5 


2 


13 


2 


5 


3 


10 


14 


49 


20 


83 





5 


2 


7 


2 


10 


3 


15 


8 


9 


10 


27 


1 


8 


4 


13 


1 


4 


1 


6 


2 


1 





3 





12 





12 


25 


70 


31 


126 


5 


6 


4 


15 


2 


4 


5 


11 


3 


5 


7 


15 


8 


27 


11 


46 


2 


6 


1 


9 


5 


22 


3 


30 


2 


5 


4 


11 





5 


1 


6 





1 


3 


4 








5 


5 



Total Number of Viable Babies (Twins — 33 Sets) 
Born Alive 3201 





HOME DELIVERY 


HOSPITAL DELIVERY 


TOTAL 






Wh. 


Col. 


Service 


Private 


L. 

1 
21 

47 
229 
298 

90.6 


D. 

2 

12 

12 

5 

31 






Wh. 


Col. 


L. 



4 

4 

44 

52 


D. 



2 
1 
3 


a 




L. 






1 
1 


D 








L. 


3 

4 
25 
32 


D. 


4 
1 
1 
6 


L. 





6 

36 

42 


D. 

1 

3 
1 

5 


L. 

1 

14 

33 

123 

171 


D. 

1 

8 

6 

2 

17 


5§ 


Birth weight — less than 1000 gms 

1000 to 1499 gms 

1500 to 1999 

2000 to 2499 


67 

36 

20 

9 


All premature live briths 

Salvage 


9.4 


Term live births (2500 plus gms.) 


9 


1 


437 


4 


420 


1 


1185 


8 


802 


5 


2853 


19 





DEPARTMENT OF OBSTETRICS— ANNUAL REPORT 



35 



Premature Labor — Causes of 



Induced 

Toxemia 

Preeclampsia 

Hypertensive disease 

Hemorrhage 

Placenta previa 

Placenta — premature separation of 

Diabetes 

Hydramnios 

Elective 

Spontaneous 

Toxemia 

Preeclampsia 

Hypertensive disease 

Hemorrhage 

Placenta previa 

Placenta — premature separation of 

Other hemorrhages 

Membranes — premature rupture of. . 

Syphilis 

Hydramnios 

Pregnancy multiple 

Disease — maternal — acute infectious 

Pathology — cervical 

Fetus — abnormalities of 

Fetus — intrauterine death of 

Maternal disease 

Cause undetermined 



HOME DELIVERY 


HOSPITAL DELIVERY 






Service 




Wh. 


Col. 




Private 






Wh. 


Col. 










3 


14 


7 








3 


10 


3 








2 


9 


3 








1 


1 














4 


1 











1 


1 











3 

















1 














1 














1 


1 


44 


47 


197 


55 





6 


3 


34 


3 








2 


22 


3 





6 


1 


12 








2 


3 


14 


9 





1 





1 








1 


2 


9 


8 








1 


4 


1 





5 


2 


19 


14 





4 


2 


16 











1 


3 








6 


7 


13 


4 











3 














4 











2 


7 


2 











6 


3 











2 





1 


21 


27 


76 


20 



24 

16 

14 

2 

5 

2 

3 

1 

1 

1 

344 

46 

27 

19 

28 

2 

20 

6 

40 

22 

4 

30 

3 

4 

11 

9 

2 

145 



Etiology of Neonatal Mortality (Stillbirths and Deaths in Live Born) 



Hemorrhage intracranial 

Disproportion cephalopelvic 
Delivery vertex-traumatic . . 

Delivery breech 

Unknown 

Precipitate labor 



PREMATURE 



Home delivery 


Hospital delivery 


Wh. 


Col. 



Sen 
Wh. 


/ice 
Col. 


Pri- 
vate 





1 


1 









































1 

















1 





















FULL TERM 



Home delivery 



Wh. 



Col. 



Hospital delivery 



Service 



Wh. 



Col. 



Pri- 
vate 



11 

5 
1 
4 

1 



36 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF AID. 



Etiology of Neonatal Mortality (Stillbirths and Deaths in Live Born) — Continued 



Anoxemia 

Placenta — premature separation 

of 

Placenta previa 

Toxemia 

Cord-umbilical compression of . . 

Complications — medical 

Diabetes 

Undetermined 

Development — anomalies of 

Infections 

Syphilis 

Pneumonia 

Prematurity 

Disease — hemolytic — congenital . 

Diabetes 

Undetermined 



PREMATURE 



Home delivery 



Wh. 



Col. 



12 

1 
1 

2 



8 











Hospital delivery 



Service 



Wh. Col 



15 

9 

1 
5 




3 
7 
5 
2 
8 


6 



Pri- 
vate 



FULL TERM 



Home delivery 



Wh. 



Col. 



Hospital delivery 



Service 



Wh. Col 



Pri- 
vate 



Maternal Morbidity* 





HOME DELIVERY 




Wh. 








Rate 








Col. 

13 

10 

10 






Rate 

2.6 

2.0 

2.0 






All causes 

Birth canal only 


Delivery spontaneous 

Delivery operative below 

Delivery operative above 



HOSPITAL SERVICE 



Wh. Rate Col. Rate 



1() 

17 
2 

13 
2 



5.5 
3.6 
1.2 
4.2 
16.7 



95 

65 
21 
26 
18 



6.7 
4.6 

3.4 

3.5 

25.4 



PRIVATE 


TOTAL 


No. 


Rate 
4.1 


No. 


Rate 


37 


171 


5.2 


25 


2.7 


117 


3.5 





0.0 


2>2> 


2.4 


22 


3.0 


61 


3.4 


3 


10.0 


23 


20.0 



*The criterion used for maternal morbidity is the standard of a temperature elevation to 100.4 
degrees or over on any two days of the puerperium excluding the day of delivery. 

Adult Deaths 



Non-maternal mortality. ...... 

Maternal morality 

Registered clinic patients. . . . 
Non-registered clinic patients 
Private patients 



WH. 


COL. 











1 





1 















DEPARTMENT OF OBSTETRICS— ANNUAL REPORT 
Mortality Rate per 1000 Live Births 



37 





TOTAL 


RATE 


WT. 


RATE 




COL. 


RATE 


Registered clinic 


1 



1 


0.5 
0.3 








1 




1 


0.7 


Non-registered clinic 








Combined 


0.7 



Causes of Adult Deaths 
1. Spinal Anesthesia 

Maternal Death: 

A 16 year old, colored, registered, Rh positive, STS negative, para 0000 was admitted at 6 P.M 
on December 8, 1949 in active labor with membranes ruptured. On admission the cervix was 4-5 
cm. dilated and 1 cm above the ischial spines. The prenatal course revealed a contracted inlet. At 
9:00 P.M. the cervix was 6 cm. dilated and on sterile pelvic examination the fetal head was 2 cm. 
above the ischial spines with molding and caput. A caesarean section was decided upon. At 9:18 
P.M. a spinal anesthesia with- 10 mgm. pontocaine in 10 per cent glucose and 25 mgm. ephedrine was 
given. A puncture was made at the third interspace, the patient tilted 10 degrees for 20 seconds and 
then placed level. Her blood pressure was 116 systolic over 70 diastolic. The anesthesia level was 
T-6. Her blood pressure was rechecked immediately and not obtained. Oxygen by positive pres- 
sure was started and patient intubated. She was given whole blood intravenously and adrenalin 
was injected into the heart. The patient died at 9:33 P.M. A post mortem section was successful. 



Post mortem examination — Gross pathology- 
congestion and petechial cerebral hemorrhages. 



-nothing unusual. Microscopic — Slight cerebral 






CLINICO-PATHOLOGIC CONFERENCE 
From the Case Histories, University Hospital, Baltimore 

Clinical History 

A 55 year old white female was admitted to the medical service for diagnostic 
study because of "colitis" and palpitation of the heart. In March, 1950 she began 
to have diarrhea and cramping pains in her lower abdomen for which she was given 
sulfasuxidine. After some improvement there was a return of nausea, diarrhea and 
abdominal discomfort. Her abdomen became distended because of flatus. There was 
no vomiting. She had numerous loose mucoid stools each day. 

A history of fatigability and weight loss, later followed by palpitation, shortness 
of breath and orthopnea was evident. The family history was not significant. Her 
mother died of cerebral hemorrhage. The past history included two surgical opera- 
tions, an appendectomy and right salpingo-oophorectomy thirty years previously. 
Twelve years previously she had a cholecystectomy. 

An examination on admission revealed a temperature of 98.6 F.; pulse, 84; respi- 
rations, 20; blood pressure, 150 systolic over 80 diastolic. The patient was a well de- 
veloped, obese white female complaining of palpitation and fatigue after walking 
around the bed. The trachea was in the midline. The thyroid gland was normal. 
There was no venous engorgement or cervical adenopathy. The breasts were large, 
pendulous and free of palpable masses. The note elicited by percussion over the lungs 
was resonant. The breath sounds were vesicular. There were no rales. The heart was 
of normal size. No murmurs were heard. There was a healed upper right rectus ab- 
dominal scar. There were no abdominal masses or tenderness. Borborygmus was 
present. There was no cyanosis of the extremities. Varicosities were present in the 
right leg. Pitting edema existed in both feet. The deep tendon reflexes were normal. 

The white blood cells numbered 7,800 per cubic millimeter, of which 54 per cent 
were neutrophilic polymorphonuclear granulocytes; 41 per cent, lymphocytes; 1 per 
cent, monocytes; and 4 per cent eosinophilic polymorphonuclear granulocytes. Blood 
platelets were normal. The blood urea nitrogen was determined to be 9 milligrams 
per hundred cubic centimeters. The blood sugar concentration was 80 milligrams 
per hundred cubic centimeters. A serologic test for syphilis was negative. Inversion 
of T waves was noted on the electrocardiogram. There were no demonstrable para- 
sites in the stools. Roentgenographs of the chest, skull, and upper gastro-intestinal 
tract were insignificant. The barium enema (Fig. 1), was helpful in making the 
diagnosis. 

On June 12 a section of bowel was removed. Post-operatively the patient did well 
and was allowed up on the day after operation. However, on the 14th of June her 
temperature rose to 100.6 F. and pulse rate, to 100 per minute. An examination at 
this time revealed fine rales in both bases. On the 19th of June a superficial phlebitis 
developed in the dorsal vein of the right foot. The patient was given dicumarol and 
aureomycin. The prothrombin time was maintained at 45 to 55 per cent. The tem- 
perature and phlebitis gradually subsided. She was discharged on July 3, 1950. 

38 



CLINICO-PA THOLOGIC CONFERENCE 



39 




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+-> cd 3 

8 * .1 



t3 -d 

bo 43 



fe rC 



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p CO 

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40 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

Clinical Discussion 

Dr. T. R. Adams: So far as I am concerned, this case is an almost insoluble conun- 
drum. There is surprisingly little information that would lead me to a diagnosis. 
However, there are several things that should be considered in trying to make a diag- 
nosis in this patient. I am going to assume that she had her trouble mainly in the 
colon. There are many things that could cause the signs and symptoms in this pa- 
tient. Some are uncommon and some quite rare. First, hyperplastic tuberculosis of 
the colon, although deserving of consideration, would not permit the degree of health 
and adiposity seen in this woman. Another possibility is polyposis of the colon. A 
polyp could, without actual bleeding, cause the mucous colitis that she supposedly 
had. A polyp could cause cramps and abdominal distension, either by its mass alone 
or by its precipitating the formation of an intussusception. Another possibility, 
syphilis, is discarded because of the negative serology. In chronic ulcerative colitis, 
there are often bloody, mucinous stools, there is, however, a possibility of a seg- 
mental type of colitis. We have all seen malignant tumors of the ovaries, uterine 
body, and cervix involving the colon. That could cause the syndrome seen in this 
patient. Her genital history is negative except for the removal of a tube and ovary 
many years ago. Endometriosis should be considered in this case. This woman had 
a hemoglobin of 95 per cent. She had not lost much weight. Endometriosis could 
very well cause almost complete obstruction. Infrequently, one sees submucous 
lipomata of the colon, which could give this clinical course. It could cause the par- 
tial obstruction and mucous diarrhea. Intermittent volvulus of the sigmoid colon 
might be added to this differential study. Mesenteric vascular occlusion, although 
it is not very common, could cause an illness such as this patient experienced. Ad- 
hesions causing partial obstruction may block the large bowel, but I do not recall 
seeing it. Something else that comes to mind is a carcinoma of the stomach with 
implants in the pelvis that might impinge upon the bowel. In the absence of symp- 
toms of gastric disease, this possibility is excluded. Post irradiation strictures of the 
colon are not indicated by this patient's history. 

The best supposition in considering this case is a diverticulitis. This woman had 
a normal hemoglobin, she had lost little or no weight, and she had symptoms of par- 
tial obstruction. Diverticulitis should certainly be strongly suggested when one re- 
members that 5 per cent of all persons over the age of 40 have diverticulosis. Only 
about 8 to 10 per cent of that group suffer inflammatory complications. I am sur- 
prised that this patient was not sigmoidoscoped. 

Dr. D. J. Bar net t: The interest in this case, of course, is in the barium enema. 
The preliminary examination of the abdomen showed no evidence of intestinal ob- 
struction. On starting the enema, the barium suspension flowed very easily through 
the entire colon. The distal half of the colon appeared distended. No peristaltic 
activity was manifested in the right half of the colon (Fig. 1). At the junction of the 
cecum, a filling lesion was demonstrated on the film made in a directly anterior- 
posterior position. It demonstrated the lesion to lie in the midline. We know the 
lesion was posterior and that it had a relatively smooth outline and indistinct lobu- 
lations (Fig. 2). The barium suspension could not be forced into the ileum. After 
evacuation, the filling defect was still visible at the junction of the ileum and colon. 



CLINICO-PATHOLOGIC CONFERENCE 41 

A relatively normal mucosal pattern was seen on the proximal half, but on the dis- 
tal half the mucosa was in parallel bands and relatively flattened (Fig. 3). These 
shadows were interpreted as indicative of malignancy or an old inflammatory proc- 
ess of the cecal wall. 

Dr. Adams: This looks to me like late ulcerative colitis with scarring. As I suggested 
in the beginning, one certainly would have seen that with the aid of the sigmoido- 
scope. If this is a carcinoma of the cecum, it certainly has not caused symptoms that 
one usually sees in carcinomas involving the right half of the colon. One usually 
finds that the hemoglobin is much lower than would be expected after finding little 
blood in the stools. She had a hemoglobin concentration of 95 per cent even after 
being ill for 3 or 4 months. Off-hand, one would not think that this was a carcinoma 
of the cecum. The roentgenograph wouldn't appear thus if it had been carcinoma. 
Extensive ulcerative colitis is my diagnosis. 

Dr. H. C. Hull: I am not sure of what she had, but I make the hazardous diag- 
nosis of submucous lipoma. At any rate, I think the lesion is a benign tumor. 

Dr. H. R. Spencer: On what basis do you explain the lack of bleeding? 

Dr. Hull: There was ho erosion of the mucous membranes. 

Dr. R. C. Sheppard: I would like to ask Dr. Adams what he thinks of "carcinoid" 
as the diagnosis? 

Dr. Adams: The reason I did not mention it in the diagnosis was because I was 
so sure that the lesion in this case was on the left half of the colon. Carcinoid tumors 
are sometimes malignant, but very slow growing lesions that only occasionally 
metastasize. 

Dr. Spencer: Carcinoids do not bleed. Those that occur in the appendix are invari- 
ably benign. Those that occur in other parts of the intestinal tract may metas- 
tasize. 

Dr. G. Govatos: I believe she had a tumor invaginating the wall. Either a polyp 
or a lipoma comes to my mind. Some roentgenologists think that submucous lipomas 
are a little more translucent. 

Dr. Barnett: That would depend on the size. 

Dr. Govatos: Another thing one must remember about submucous lipomas is that 
if they get large enough they might bleed. 

Dr. C. R. Edwards: I believe that the most important feature of this case is the 
intermittent diarrhea and the smoothness of the deformity in the right colon. As a 
rule, of course, we know that any neoplasm in the right colon may lead to anemia. 
There are few exceptions. The so-called "napkin-ring" carcinoma which does not 
extensively ulcerate is one. The majority of the malignancies of the right colon are 
of the ulcerative type. When a patient of this age is presented with anemia and a 
tumor in the right colon, carcinoma is the most probable diagnosis. Many neoplasms 
of the right colon are not obstructive. This woman's symptoms were indicative of 
obstruction. Prolapse of a polyp with the formation of an intussusception would 
probably cause bleeding. In the chronic types of intussusception blood often appears 
in the stools. Whether it is a prolapse or whether it is an intussusception, if it is 
going to cause as much deformity as is seen in the roentgenograph in this case, almost 
invariably it will be associated with some blood in the stools. This case emphasizes 



42 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

the importance of doing an exploratory laparotomy where questionable roentgeno- 
logic findings couple with signs of partial colic obstruction. 

It is a very unfortunate thing that the majority of the diagnoses of endometriosis 
are not made prior to operation. If one will examine the history of a case where endo- 
metriosis is definitely defined by operation and pathologic studies, intermittent 
regression of the symptoms will be indicated. Endometriosis invading the bowel 
wall has been reported in almost every segment of the colon. 

Pathological Discussion 

Dr. H. R. Spencer: The gross specimen in this case consisted of the cecum and 29 
cm. of terminal ileum. The ileum was acutely angulated and adherent to the side 
of the cecum. The serous surfaces were otherwise normal. Longitudinal section 
through the cecum, ileum, ileocecal valve and ascending colon showed the ileocecal 
ostium to be surrounded by pouting resilient mucosa and submucosa that protruded 
1.5 cm. into the colon. This deformity consisted of a doughnut shaped protrusion 
of ileal mucosa that was pushed distally by excessive growth of submucous fat. 
The stroma was edematous and sparsely infiltrated by lymphocytes. There was no 
evidence of ulceration or malignancy. 

This is a case in which partial intussusception and obstruction were caused by a 
submucous lipoma. Lipomas of the intestinal tract are not common. They arise 
either in the adipose tissue of the submucosa or of the subserosa. The submucous 
tumors of this type usually are not large but in about one-half of the cases can cause 
intussusception. 

Diagnosis: Submucous lipoma, terminal ileum. 



OBSTETRIC CASE REPORT* 

The patient, an 18 year old secundigravida was admitted to the hospital at 2: 15 
A.M., October 20, 1950 in advanced labor. Her first pregnancy was accompanied by 
pre-eclampsia, and terminated with a living baby. Her present prenatal course was 
entirely satisfactory. 

Labor began at 1:45 A.M., at home. On admission she was ready for delivery. A 
saddle block anesthesia was instituted at 2:30 A.M., and at 2:50 A.M. she was 
delivered spontaneously and without lacerations of a full term, living, female child. 
The delivery was rapid. At 2:55 A.M. the placenta and membranes were expressed 
intact. Immediately following completion of the third stage, pitocin was given in- 
tramuscularly. Cervical inspection and vaginal inspection were negative. 

Two hours postpartum there was moderate vaginal bleeding with uterine relaxa- 
tion; however, the uterus would become firmly contracted when massaged. Five 
hours postpartum, she began to bleed profusely, and massage only moderately con- 
trolled the hemorrhage. Intravenous fluids were started with one ampule of pitocin 
added to 500 c.c. of 5 per cent glucose administered at a moderately rapid rate. 
Within a very few minutes the uterus contracted firmly and continuously and bleed- 
ing ceased. Her further course was uneventful. 

Diagnosis: Delayed postpartum hemorrhage as a result of uterine atony. 

Discussion: The cause of postpartum uterine atony is unknown. We do know 
that it follows precipitate and prolonged labors, hydramnios and twin pregnancies. 
In its treatment there is one maneuver that may prophylactically decrease its in- 
cidence. That procedure is the slow extraction of the baby, particularly after the 
head has been born. Forty-five to 60 seconds should be used to deliver the remainder 
of the body. This aids in immediate placental separation and decreases the third 
stage blood loss. 

Active therapy should consist of the following: 1) preparation for immediate trans- 
fusion and liberality in its use; 2) massage, either externally or a combination of the 
fist in the vagina against the uterus and the external hand massaging the uterus; 
3) intravenous ergotrate; 4) pitocin as was given to the above patient; that is, as 
an intravenous drip in isotonic glucose or normal saline; 5) manual exploration of 
the uterus, and visual inspection of the cervix and vagina for retained secundines 
and lacerations; and 6) if uncontrollable with these methods, an abdominal hys- 
terectomy should be done. 

All cervical and vaginal lacerations should be repaired immediately. In many in- 
stances abdominal hysterectomy is postponed too long with disastrous results to the 
mother. If the first 5 steps do not control the hemorrhage, other procedures, such 
as packing of the uterus will probably be of no avail. Hysterectomy is then a life- 
saving procedure. 

* From the Department of Obstetrics, Univ. of Maryland, School of Medicine, Baltimore. 



43 



BOOK REVIEWS 

Textbook of Bacteriology. Joseph M. Dougherty, A.B., M.A., Ph.D., Dean of the School of Science 
and Professor of Bacteriology, Yillanova College; and Anthony J. Lamberti, B.S., M.S., Instructor 
in Bacteriology and Parasitology, Temple University School of Medicine. The C. V. Mosby Com- 
pany, St. Louis, Missouri, 1950. 491 pp. Price $5.75. 

This is a text for undergraduate students and is well-suited for introducing bacteriology to pre- 
medical and pre-dental students and for nurses' instruction. 

The student is introduced to the subject by way of a rather concise, though highly informative, 
review of the history of bacteriology. This is followed by a chapter on microscopy; a logical sequence 
since much of the rapid progress in the development of bacteriology depended upon the perfection 
of the compound microscope. The chapter on microscopy is extended to include the valuable con- 
tribution of the electron microscope to bacteriology. 

Those chapters dealing with bacteriologic technique, apparatus, cultural methods and staining 
are well presented and are amply supplemented with tables, illustrations, and diagrams which are 
too often slighted in elementary texts. Such treatment of these phases of bacteriology is of practical 
value. The effects of physical and chemical agents on bacteria are well-treated and a chapter on 
chemotherapeutics is remarkably well up to date. 

Six chapters are devoted to various phases of the infectious process, immunology and serology. 
Particularly impressive is the thoroughness with which the complement fixation reaction is con- 
sidered, the procedure demonstrated being a modification perfected by Dr. John A. Kolmer. These 
chapters would serve well in the establishment of a foundation in immunology and serology for the 
elementary student in bacteriology. 

Some twenty groups of organisms are considered with regard to morphology, cultural character- 
istics, pathogenicity for man and animals, immune and serologic responses elicited, therapy and 
other information where pertinent; for example, toxin production, antigenic types, specific tests and 
distribution of the organism. The inclusion of the actinomycetes, pathogenic fungi, rickettsia and 
filtrable viruses produces a well rounded representative presentation of pathogenic microorganisms. 
Chapters dealing with the bacteriology of water, milk and food as well as the parasitic protozoa 
are of practical value to the future technician. 

The reviewer feels this text to be an excellent one for introducing the science of medical bac- 
teriology to the undergraduate student destined to major in medicine or an allied field. It is written 
in a style which is both lucid and vivid and for the student interested in enlarging upon the basic 
presentations, there is an ample provision of references to original investigation or other authorita- 
tive sources. 

Andrew G. Smith, Ph.D. 

Freud: Dictionary of Psychoanalysis. Edited by: Nandor Fodor and Frank Giynor. The Philo- 
sophical Library, Inc., New York, 1950. Price, $3.75. 

It would be an almost impossible task to measure the extent of current professional and lay in- 
terest in Freud's system of psychoanalysis. This wide-spread popularity of psychoanalysis has caused 
much of its terminology to become a part of the vocabulary of the average layman with the result 
that far too many Freudian concepts and terms have been distorted and have lost their original 
meaning. This is so true that the interested, intelligent layman, the beginning student of psycho- 
analysis, and the researcher, have had a difficult time determining just what was Freud's definition 
and meaning of his terms. The only recourse open to those who desire to know authoritatively what 
Freud meant is either to wade through his voluminous tomes or else seek out a psychoanalytic ex- 
pert — neither of which is practical or satisfactory. This problem, happily, no longer exists, thanks 
to the fruitful efforts of the editors of the Dictionary of Psychoanalysis. 

This book should prove useful and practical to anyone who is interested in psychoanalysis. It is 
an authoritative, well planned, comprehensive Freudian glossary, alphabetically arranged, with an 
introductory key to references to complete and further simplify its use. This publication is thorough 
and leaves little to be desired by those for whom it is intended. The format and the selection of 

44 



BOOK REVIEWS 45 

type is attractive, makes for easy reading and contributes to the book's value. As a hand}' reference 
this volume belongs on the shelf of students and critics of psychoanalysis. The editors, aptly state: 
"This is a book that should satisfy a long-felt need" and we are pleased to recommend it. 

Frank J. Ayd, Jr., M.D. 

The Management of Obstetric Difficulties. Paul Titus. 4th Edition, 1950. The C. V. Mosby 

Co., St. Louis, Missouri. Price $14.00. 

In its first 3 editions, this volume has been characterized by excellent evaluation of abnormal 
obstetrics and of sterility. The fourth edition follows this same pattern. With particular reference 
to management, the subject matter in many instances is unilateral in its approach and frequently 
omits the points of view of other obstetricians which are in opposition to the author. By and large, 
this is not true, and a well rounded plan of management for an)' one obstetric difficulty can be ob- 
tained. Man}' of the sections have been enlarged, such as diabetes, placenta previa, German measles, 
with the addition of new sections dealing with granuloma inguinale, multiple sclerosis, infectious 
hepatitis and poliomyelitis. 

There have been advances made in classification and terminology with the agreement of Titus, 
McCormick, Greenhill and Eastman in their four major textbooks. The classifications of the toxe- 
mias of pregnancy have been agreed upon as well as the definition of placenta previa and the elim- 
ination of the term premature separation of the placenta with abruptio placenta substituted. This 
agreement will enable obstetricians in general to more clearly evaluate and interpret results of the 
management of these three obstetric difficulties. 

There is some misplacement of values from the standpoint of space dedicated to some obstetric 
difficulties. For example, only three or four pages are devoted to the management of the frequent 
complication of contracted pelvis, while some 11 to 12 pages are devoted to the preparation and 
use of dextrose solutions. This may well represent enthusiasm on the part of the author for this 
particular form of intravenous therapy. 

The illustrations are not only numerous and well planned, but also expertly prepared. On the 
whole, the textbook is clearly written, well programed and can be recommended for both reference 
and teaching. 

D. Frank Kaltreider, M.D. 



MEDICAL SCHOOL SECTION 
GENERAL PATTERSON DIES 




Dr. Robert U. Patterson 

Major General Robert Urie Patterson, MC, USA, (ret.), former Surgeon General 
of the United States Army and Dean Emeritus of the School of Medicine, died on 
December 6, 1950 at Walter Reed Hospital, Washington after a short illness, aged 73. 

General Patterson was born in Montreal, Canada in 1877, receiving his medical 
degree at McGill University in 1898. In 1901 he joined the Medical Corps of the 
United States Army and after a succession of stations in the Philippines and at 
various army posts throughout the United States he became Chief of a Medical 
Unit in World War I. 

In 1931 he was raised from the rank of Colonel to Major General and appointed 
Surgeon General of the Army, serving in this capacity until 1935 when he was re- 
tired. He then became Dean of the University of Oklahoma School of Medicine, 
from which post he was appointed Dean of the School of Medicine of the University 
of Maryland, serving in this capacity from 1942 until 1946 when he was forced to 



ii BULLETIN OF THE SCHOOL OF MEDICINE, U. OF Ml). 

retire because of ill health. As Dean of the School of Medicine during the war years, 
his forceful personality contributed greatly to the maintainence and continuation 
of high standards during a time when medical school faculties and educational fa- 
cilities were subject to considerable depletion. 

He was instrumental in the institution of a program which ultimately lead to the 
expansion of the post graduate training facilities of the School of Medicine. During 
the war years he initiated the Planning Committee which was largely responsible 
for the constructive post war program which is still in progress. 

CANCER SEMINAR PROGRAM— 1950-51 

Third Wednesday in every month from 4 until 5 P.M. (unless otherwise noted) 
Date Speaker Subject 

Monday, January 22, 1951, Dr Sidney Farber Tumors in children 

at 5 P.M. Children's Medical Center 

Boston, Mass. 

February 21, 1951 Dr. Richard Sweet Carcinoma of the esophagus 

Mass. General Hospital 
Boston, Mass. 
The remainder of the year's program has not been completed. 

ARMY SURGEON GENERAL EXPLAINS MEDICAL DRAFT 
COMMISSION DEADLINE 

In response to numerous inquiries relative to the final date on which draft eligible 
physicians and dentists may receive preinduction reserve commissions, Major Gen- 
eral Raymond W. Bliss, Army Surgeon General, emphasized today that the me- 
chanics of processing applications preclude the guarantee of a commission to a reg- 
istrant if he applies after receiving his induction notice. 

This commission deadline, General Bliss explained, is the result of administrative 
considerations. Section 5 of Public Law 779, 81st Congress, simply provides that 
"no person inducted under the provisions of this Act shall be entitled to the benefits 
of the provisions of Section 203 of Public Law 351, 81st Congress." {$100.00 monthly 
incentive bonus — ed.) However, for physicians and dentists to qualify as volunteers, 
and thus for the special professional pay authorized under Public Law 351, all proc- 
essing required for a reserve commission must be accomplished and appointment 
made prior to induction. 

"Because of the work load involved in processing an application for reserve com- 
mission, and the controls necessary for a decentralized Selective Service system, as 
well as a decentralized Army appointment system, we simply cannot guarantee that 
a registratn can receive his commission in time if he applies after he has received 
his induction notice," General Bliss said. "This, of course, does not preclude any 
registrant applying for his commission after he has received his induction notice, 
and if he receives a commission before actual induction, he is entitled to all the 
benefits provided for commissioned officers." 



MEDICAL SCHOOL SECTION iii 

DEPARTMENT OF PHARMACOLOGY 

Go Lu, M.D., was appointed a Fellow in Pharmacology as of September 1, 1950. 

Dr. John C. Krantz, Jr., gave the Convocation address at the University of 
Buffalo on October 20, and while in Buffalo spoke to the staff of the Maternity 
Hospital of the University of Buffalo, and addressed the annual banquet of the 
Torch Club of the city. 

APPOINTED ASSISTANT PROFESSOR OF PHARMACOLOGY 




Dr. Raymond M. Burgison 



The appointment of Dr. Raymond M. Burgison as Assistant Professor of Phar- 
macology was announced on September 1, 1950. 

Dr. Burgison, a native Baltimorean and a graduate of Loyola College, received 
his Doctor of Philosophy degree from the University of Maryland School of Phar- 
macy in June, 1950. During his postgraduate training he held the Ohio Chemical 
Company Fellowship in the School of Medicine from 1948 to 1949, and from 1949 
to 1950 was the Eli Lilly Fellow in Pharmacology. Prior to his entrance into the 
graduate school of the University he worked as an industrial research chemist and 
during World War II was active in rubber research. 

In the department of Pharmacology, Dr. Burgison will continue investigations 
with drugs used in the treatment of cardiovascular diseases. 



iv BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

DEPARTMENT OF PHARMACOLOGY 

The Department of Pharmacology has received a grant of $4500 from Eli Lilly & 
Company for the study of cardiovascular drugs, and a grant of $3500 from the Air 
Reduction Company for a continuation of studies in anesthesia. 

Go Lu, M.D., is enrolled as a graduate student in this department. 

Dr. John C. Krantz, Jr., gave 5 lectures at the Atlantic City General Hospital 
and served as a consultant to the hospital for the week of June 11. 

Dr. Krantz will be the speaker at the annual banquet of the Surgical Society of 
San Diego, California, September 13, and will also speak on September 14 at the 
Medical Society of Hollywood. 

GRANT AWARDED 

A recent grant of $6,000 from the United States Public Health Service has been 
awarded to the Department of Pharmacology for continuing studies in the phar- 
macology of drugs applicable to the treatment of hypertension. 

NOTES FROM THE DEPARTMENT OF OBSTETRICS 

On July 1, 1950, Dr. Schuyler G. Kohl resigned from our faculty to accept an 
appointment under Dr. Louis M. Hellman, Professor of Obstetrics, and Gynecology 
at the State University of New York, School of Medicine, at Brooklyn, New York. 

New appointments to the obstetric staff of the school include: Drs. J. Tyler 
Baker, Harry McB. Beck, Wm. A. Dodd, Irvin P. Klemkowski, Clarence W. 
Martin and Harry Cohen. 

At the November meeting of the Southern Medical Association in St. Louis there 
were two papers presented by members of the obstetric department. The first was 
by Drs. J. M. Reese and C. W. Martin and the second by Drs. I. A. Siegel and 
H. B. McNally. In both instances, the paper was read by the senior author. 

With sorrow we report the sudden and untimely death of Dr. Robert F. Linn 
on Sept. 27, 1950. Dr. Linn was resident in obstetrics at the University Hospital 
1941-42 after which he entered the armed forces, and upon completion of his tour 
of duty, went into practice in Cleveland, Ohio, his home. A successful obstetrician, 
Dr. Linn enjoyed the respect of his confreres. Dr. Linn was just 40 years of age 
when he died, death being due to coronary occlusion. 

Dr. W. Paul Dailey, Harrisburg, Pa., resident in obstetrics at the University 
1930-32 was recently elected President of the Harrisburg County Medical Society. 

"DOUGTRICLVNS" ORGANIZE 

In June 1949 a number of the past obstetric residents of the University and Balti- 
more City Hospitals met at the University Hospital to organize "the dougtricians." 
All present were former residents of Dr. Louis H. Douglass, thus the derivation 
of the name of the society. The meeting consisted of clinics and case presentations. 
In the evening a dinner was held at the Baltimore Country Club. A permanent or- 
ganization was formed at this initial meeting. 

The second annual meeting and dinner was held at the Hotel New Yorker, New 



MEDICAL SCHOOL SECTION v 

York, in May 1950 in conjunction with the International and Fourth American 
Congress of Obstetrics and Gynecology. Eighteen members were present. Dr. Louis 
H. Douglass, the guest of honor, made a brief talk. Dr. J. Morris Reese, Presi- 
dent, presided. 

It is planned to hold the third annual meeting in June 1951 in conjunction with 
the Medical Alumni meetings. 

Dr. John C. Krantz, Jr., Professor of Pharmacology, has been recently elected 
an honorary member of the Hollywood Academy of Medicine, Hollywood, California. 

DEPARTMENT OF DERMATOLOGY 

Recent publications by the Department of Dermatology include the following. 

By Drs. H. M. Robinson, H. M. Robinson, Jr. and H. V. Link — Studies in the 
Treatment of Tinea Capitis. (I) Furaspor in the Treatment of Tinea Capitis. Bull. 
Sch. Med., U. of M. 

By Dr. Israel Zeligman — Red Fluorescence of Urine in Wood's Light as Aid in 
Office Diagnosis of Poprhyria. Archives of Dermatology and Syphilology. May 1950. 

By Dr. Francis A. Ellis — The Vesicular Form of Darier's Disease (so-called benign 
familial pemphigus). Archives of Dermatology and Syphilology. May 1950. 

By Dr. Eugene Bereston — Treatment of Kaposi's Varicelliform Eruption with 
Aureomycin. Archives of Dermatology and Syphilology. 

By Dr. H. M. Robinson — Chloramphenicol (Chloromycetin) in the Treatment of 
Chronic Discoid Lupus Erythematosus. Journal of Investigative Dermatology. May 
1950. 

Aureomycin in the Treatment of Some Dermatoses. Archives of Dermatology and 
Syphilology. March 1950. 

By Drs. H. M. Robinson and H. M. Robinson, Jr. — Terramycin in the Treatment 
of Early Syphilis and Gonorrhea. (In preparation.) 

Studies on Chloramphenicol in Early Syphilis and Gonorrhea. Southern Medical 
Journal. November 1949. 

The Antibiotics in the Treatment of Early Syphilis and Syphilis Complicated by 
Pregnancy. Read at the American Medical Association Meeting. 1950. 

The Use of Aureomycin, Oral, Intravenous and by Local Application in the Treatment 
of Dermatoses. To be read in November 1950 before the section of dermatology of the 
Southern Medical Society. 

By Drs. H. M. Robinson, H. M. Robinson, Jr. and R. C. V. Robinson — The Thera- 
peutic Value of Aureomycin in Dermatitis Herpetiformis. The Journal of Investiga- 
tive Dermatology. July 1949. 

By Dr. R. C. V. Robinson — Benzyl Benzoate in the Treatment of Tinea Capitis. 
October, 1949. 

By Dr. H. M. Robinson, Jr. — Comparative Analysis of the Mucocutaneous Ocular 
Syndromes. Archives of Dermatology and Syphilology. May 1950. 

The Ocular Mucous Membrane Syndrome. Accepted for publication in the Medical 
Clinics of North America. 

Keratosis Follicularis. Archives of Dermatology and Syphilology. July 1950. 

Dr. Francis A. Ellis and William Bundick will present an exhibit at the Southern 



vi BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

Medical Meeting in St. Louis in November, 1950, entitled: The importance of Biopsy 
in Diagnosis and Prognosis in Classification of Lupus Erythematosus. 

Dr. H. M. Robinson, Jr. is preparing an exhibit on Visual Aids in the Teaching of 
( T nder-graduate Dermatology. 

Drs. H. M. and R. C. V. Robinson recently presented a paper on Modem Approach 
to Skin Diseases at the Peninsula General Hospital, Salisbury, Maryland. 

Dr. H. M. Robinson, Jr. recently lectured at the Howard University Medical 
School, Washington, D. C. on Rarer Dermatoses. 

DEPARTMENT OF PSYCHIATRY 

New appointments in the clinical staff of the Department of Psychiatry are Dr. 
William N. Fitzpatrick, Dr. Enoch Callaway, III, Dr. Marion W. Mathews, Dr. 
Marvin Jaffee and Dr. Virginia Suttontield. Dr. Robert G. Grenell has been appointed 
Research Associate in Psychiatry and Miss Jeannette Rayner and Mr. David Willen- 
son have been appointed Research Assistants. Dr. Ephriam T. Lisansky has been 
promoted to the position of Associate in Psychiatry. 

A contract for "Psychological Studies on the Effects of CW Agents" has been 
awarded to the Department by the Chemical Corps Procurement Agency, Depart- 
ment of the U. S. Army. Support for a research project on "Effects of Anoxia on the 
Electroencephalogram and on Behavior", which has been transferred from the Har- 
vard Medical School, has been granted by the Office of Naval Research, Department 
of the Navy. 

The Myer Dana Lectureship in Psychiatry has been established through the gen- 
erosity of Mr. Herman Dana of Boston. A grant for the support of "Studies in Med- 
ical Logic" has been likewise received from Mr. Herman Dana, Boston. 

Dr. Robert G. Grenell has read papers on "Effects of High Potassium on In 
Vivo Respiration and DC Potential of Cerebral Cortex" and "In Vivo Respiration 
of the Cerebral Cortex in the Absence of Glucose" at the Federation of Biological 
Sciences, and a paper on "Effects of Nembutal on the In Vivo Oxygen Consumption 
of the Cerebral Cortex" at the Annual Meeting of the American Neurological Asso- 
ciation. 

Dr. Whitman Newell was elected to the Presidency of the American Orthopsy- 
chiatric Society at its annual meeting in Atlantic City. He is also President of the 
Baltimore Psychoanalytic Society. 

Dr. Jacob E. Finesinger read a paper on "Managing the Emotional Problems of 
the Cancer Patient" at the annual meeting of the Georgia Medical Society, and in 
collaboration with Dr. John R. Reid, read a paper, "Inference Testing in Psycho- 
therapy" at the annual meeting of the American Psychiatric Association. He has 
also read papers before the Washington County Medical Society, the Frederick 
County Medical Society, the Baltimore City Medical Society and the Maryland 
Medical and Chirurgical Faculty and the Washington Psychiatric Society. Dr. 
Finesinger has been named to the editorial board of the American Journal of Clinical 
Investigation and has been appointed a special consultant to the National Institute 
of Mental Health. 



MEDICAL SCHOOL ^SECTION vii 

DEPARTMENT OF SURGERY 

Dr. Joseph Ganey delivered a paper on "A Study of Intestinal Flora" at the an- 
nual meeting of the American College of Surgeons in Boston. 

Dr. William D. Lynn, who completed his Residency in Surgery in July, 1950, has 
been appointed full-time Associate in the Department of Experimental Surgery and 
Clinical Research. Dr. Lynn will continue his activities in the further organization 
of the research program of the Department of Surgery. 

For the past several years the Department of Surgery has maintained an active 
affiliation with the Department of Surgery of the Peninsula General Hospital at 
Salisbury, Maryland, where one Assistant Resident from the Department of Surgery 
has been assigned on a rotating basis, changing quarterly. On July 25, 1950, an ad- 
ditional Assistant Resident was assigned to the Peninsula General Hospital for a 
6 months rotating service. 

The American Board of Surgeons recently accepted Drs. William B. Long, Henry 
A. Briele and William H. Fisher, Jr. of the Department of Surgery, Peninsula Gen- 
eral Hospital, as preceptors. These three physicians are all alumni of the University 
of Maryland School of Medicine and received the greater part of their training at 
the University Hospital. 

Recent papers published by the Department of Surgery include: 

An Attempt to Establish Collateral Circulation to the Myocardium. D. A. Reimann, 
R. A. Cowley and W 7 . T. Raby. Bull. Sch. Med. U. of M., 35: 1, (Jan.) 1950. 

Aureomycin and Chloromycetin (Chlorocamphenicol) in the Treatment of Experi- 
mental and Clinical Peritonitis. George H. Yeager, W. L. Birely, W. A. Holbrook, 
W. D. Lynn and T. G. Barnes. Bull. Sch. Med. U. of M., 35: (Apr.) 1950. 

The Treatment of Peritonitis of Appendiceal Origin with Aureomycin. George H. 
Yeager, W. D. Lynn and T. G. Barnes. This paper will be published in The Southern 
Surgeon. 

Drs. A. R. Mansberger, Jr., George H. Yeager, R. M. Smelser and F. M. Brum- 
back have completed a paper entitled A Study on Sapheno-F emoral Junction Anoma- 
lies which will appear in the October, 1950 issue of Surgery, Gynecology and Ob- 
stetrics. 

A paper entitled Terramycin in Peritonitis; Experimental and Clinical was read 
before the Conference on Terramycin at the New York Academy of Sciences in 
June, 1950 by Drs. George H. Yeager, A. R. Mansdorfer, Jr., C. D. Thomas, Jr. 
and T. G. Barnes. This paper will be published in a forthcoming issue of the academy 
journal. 

MERCY HOSPITAL 

Dr. Edgar B. Friedenwald, class of 1903, P & S, resigned on March 10, 1950, 
as Professor of Clinical Pediatrics in the School of Medicine. 

Dr. Walter D. Wise, class of 1906, P & S, is President-elect of the Medical 
and Chirurgical Faculty for 1951. 

Dr. Edward R. Dana was appointed Director of Radiology at Mercy Hospital 
and Associate in Roentgenology on the Faculty of the School of Medicine, July 
1950. 



viii BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

Dr. Harold P. Biehl, class of 1940, Resident Surgeon at Mercy Hospital from 
September 1, 1946 to August 31, 19-17, has opened an office at 11 East Chase Street, 
Baltimore. 

Dr. Michael L. DeVincentis, class of 1941, Resident Surgeon at Mercy Hos- 
pital from September 1, 1947 to August 31, 1948, became a Fellow of the American 
College of Surgeons on October 27, 1950. 

FRIEDENWALD LECTURE 

The Dr. Julius Friedenwald Memorial Lecture was given on Thursday, Novem- 
ber 2, 1950 at 8:30 P.M. Dr. Andrew C. Ivy, Vice-President of the University of 
Illinois spoke on "Physiologic Basis of the Psychosomatic Aspects of Peptic Ul- 
cer." 

MERCY ORGANIZES CHEST CLINIC 

In conjunction with the residency program in thoracic surgery established at the 
University Hospital, a chest clinic has been organized at Mercy Hospital to augument 
this training. 

A resident from the thoracic surgery service will spend two years in this specialty 
with portions of his first year spent at Mercy Hospital in the bronchoscopic clinic. 
Here he will receive instruction and practical experience in bronchoscopy, laryngos- 
copy and esophagoscopy. During this time he will also observe all the cases of tho- 
racic diseases admitted to the hospital. 

Dr. William L. Garlick, recently appointed chief of thoracic surgery at Mercy 
Hospital will be in charge. 



PROGRESS NOTE 

ill! 
1 I JH 

riii 




View of site for new Psychiatric Hospital as of November 1, 1950, showing progress of excavation 

and foundation 



MEDICAL SCHOOL SECTION ix 

MEDICAL LIBRARY NOTES 

Displayed on the balcony of the Medical Library is a collection of literature with 
illustrations on the modern treatment of poliomyelitis. This display was arranged by 
Miss Grace E. Shaw, Physical Therapist in the University Hospital 

Personal Donors to the Library 

August-October, 1950 

Mr. Thomas C. Desmond Dr. C. Reid Edwards 

Mrs. Preston W. Fishbaugh Dr. N. J. Gould 

Dr. Frank W. Ffachtel Mrs. John G. Jeffers 

Dr. Vernon Krahl Dr. Arthur M. Kraut 

Dr. Enrique Llamas Dr. William B. Patterson 

Dr. Maurice C. Pincoffs Dr. A. F. Thompson, Jr. 

Dr. H. Boyd Wylie Dr. D. L. Wilkinson 

Besides individuals who make gifts of books and journals, various foundations, 
pharmaceutical firms, medical organizations, and other libraries present material to 
this library. 

It has been mentioned before in the Bulletin what a gratifying response has been 
made by alumni and other friends of the library to the request for medical journals. 
One alumnus from Jersey City, New Jersey has been faithfully shipping discarded 
medical journals to Baltimore ever since the request appeared. The librarian recently 
received the following letter from this same alumnus: 
"Dear Mrs. Robinson: 

I have been sending you so many old medical journals that I think a few new books 
would not be amiss. Will you therefore send me a list of some of the publications de- 
sired by the library and I will be pleased to select some of them and have them sent 
to you. 

I am glad that you consider me a friend to the library. I recall the many services 
and benefits that the medical library rendered to me when I was a student at the 
University. 

Arthur M. Kraut, M.D." 

This letter is just one example of the interest which medical alumni show in the 
development of the library. 



THE UNIVERSITY OF MARYLAND 
BIOLOGICAL SOCIETY 

R. Dale Smith, Ph.D. George P. Hager, Ph.D. 

President Secretary 



During the academic year, 1949-50 the University of Maryland Biological Society 
completed the following programs which are listed below. 

November 16, 1949 

Dinner Meeting: Park Plaza Hotel, Baltimore. Speaker: Dr. R. P. Silirie, Medical 
Division, Merck and Co. Topic: Cortisone — Its Chemistry and Physiological Properties. 

December 14, 1949 

Chemical Hall, School of Medicine. Speaker: Dr. Dexter L. Reimann, Associate 
Professor of Pathology, School of Medicine. Topic: An Attempt to Establish Collateral 
Circulation to the Myocardium. (Bull. Sch. Med., U. of M.; 35: 1, (Jan.), 1950.) 

In addition, Dr. Edward B. Truitt of the Department of Pharmacology, School of 
Medicine spoke on Techniques in the Measurement of Coronary Blood Flow. 

Studies cf coronary blood flow on theophylline compounds by numerous methods were studied. A method of measur- 
ing the normal rate of flow as well as accurately reflecting the increases caused by changes in the coronary vascular bed 
were considered. The paper continues with the numerous techniques employed in the measurement of coronary blood flow 
in various physiologic states. 

January 18, 1950 

Dinner Meeting: Park Plaza Hotel, Baltimore. Speaker: Dr. Samuel R. M. Rey- 
nolds, Department of Embryology, Carnegie Institution of Washington. Topic: 
Fetal Maturity at Birth. 

In the past, a yardstick for fetal maturity has been sought in the nature of fetal development itself, and explained on 
genetic grounds alone. Consideration of facts obtained in laboratory and domestic animals, as well as in certain races of 
women shows that the control of fetal size at birth is a function of fetus : maternal relationships; that fetal size is governed 
in part by the relation of the size of the uterus to the size of the fetus, and that in every' species studied, a relationship 
exists between the size of the fetus and the shape of the uterus about the conceptus. Maturity, however, is independent 
of size, except in broad terms, among different species. 

There is a period of embryonic development in each species in which the uterus about the conceptus is essentially 
spheroidal. After a definite period of time in each species, the fetus commences to increase rapidly in size, and the uterus 
about the conceptus assumes a cylindrical shape. This change over in pattern of uterine enlargement is rapid, and occurs 
at a nearly fixed time in each species. It is called the conversion period. Using this as a fixed point in the fetus : uterine 
relationship, it is found that the maturity of the fetus at birth is a function of the proportion of the total duration of 
pregnancy which the fetus spends in an elongating or cylindrical uterus. This is substantiated by considering such diverse 
factors as appearance of ossification centers, resistance of newborn to anoxia, development of regulation of body tempera- 
ture, and general somatic development. 

February 16, 1950 

Bressler Library, University of Maryland. Speaker: Dr. Edward Steers, Depart- 
ment of Bacteriology, School of Medicine. Topic: The Mode of Action of 
Sulphonamides. 



UNIVERSITY OF MARYLAND BIOLOGICAL SOCIETY 



Two hypotheses are offered to explain the inhibition of growth of bacteria by sulfonamides. (1) The Wood-Fildes Hy- 
pothesis (1940) which holds that p-aminobenzoic acid, a structural analogue of sulfanilamide, is an essential metabolite. 
(2) The Group represented by Sevag and his co-workers (1942, 19461 who feel that sulfonamides act upon respiratory en- 
zymes thus interfering with respiration essential to growth. Sevag postulates that p-aminobenzoic acid is a non-toxic 
analogue of sulfanilamide which it can displace non-specifically from any enzyme surface without itself being inhibitory. 

The majority of data reported s : nce 1940 would tend to support and strengthen the Wood-Fildes hypothesis. I'ara- 
aminobenzoic acid has been shown to be a growth factor for certain organisms. Rubbo and Gillespie (1940) and Blanchard 
(19411 isolated it from yeast. Ratner et al., (1944) reported p-aminobenzoic acid to exist in a bound form as a glutamic 
acid peptide. Angier et al., (1946) established the structure of the peptide as consisting of pterin, p-aminobenzoic acid 
and glutamic acid moieties. The intact molecule is pteroylglutamic acid or folic acid. Miller (1944) demonstrated the de- 
creased synthesis of folic acid by Escherichia coli in the presence of sulfanilamide. Harris and Kohn (1941 ), Bliss and Long 
(1941) and Lampen and Jones (1949) presented evidence which would tend to involve p-aminobenzoic acid in the metab- 
olism of amino acids and purines. 

Work and Work (1948) on the basis of the foregoing evidence have proposed the following modification of a scheme orig- 
inally devised by Kohn (1943) to explain the mode of action of sulfonamides. 



PABA 

+ 

pterin 

+ 

^ glutamic 

acid 

+ 

Unknown 

Metabolites 



Primary Reaction 




( Folic acid 




+A 


}- Inhib by 


+B 


Sulfonamides 


+c 




I +D 



E I 
F 



Secondary Reaction 



Products essential 
for growth 



The work of Lampen and Jones (1947) and Miller (1944) play an important part in the formulation of the above scheme. 
Miller (1947) in an extension of her original work reported that sulfonamide not only inhibited the synthesis of folic acid 
by a susceptible strain of Escherichia coli, but also the synthesis of pantothenic acid. The latter synthesis was 60X more 
sensitive to sulfonamide than the former. Furthermore, while the synthesis of folic acid by the resistant strain (developed 
from the parent susceptible) was still moderately inhibited by sulfonamides, the synthesis of pantothenic acid was not 
only insensitive to sulfonamides, but also 50 per cent in excess of that of the control. Wright and Skeggs (1945) found that 
high protein diets protected rats against folic acid blood dyscrasias induced by feeding sulfasuxadine. High fat and high 
carbohydrate diets failed in this respect. Folic acid content of the feces and liver was lowered in all instances regardless 
of diet where sulfasuxadine was present in the diet. In contrast, pantothenic acid content was normal with the high protein 
diet plus the drug. 

Sevag et al. (1950), report that folic acid per se is not a growth factor for Lactobacillus arabinosus (17-5), but that the 
degradation products of folic acid (Sevag and Koft (1949)) are responsible for the growth stimulation. Furthermore, the 
apparent non-competitive antagonism between folic acid and sulfanilamide results not from the folic acid but to the con- 
trol of the pH of the medium. These findings are not compatible with those of Lampen and Jones (1947) and would tend 
to argue against the conversion, by this organism, of p-aminobenzoic acid to folic acid 

Fisher and Armstrong (1947) reported that the respiration of Escherichia coli associated with nitrogen fixation and cell 
synthesis was as sensitive to sulfonamide inhibition as was growth itself. The adherents of the Wood-Fildes school interpret 
these results as well as Sevag's respiration studies as secondary effects. 

In conclusion it should be remembered that as yet there is no direct conclusive evidence as to the actual site and mode 
of sulfonamide action. 



March 16, 1950 

Joint meeting with the Society for Experimental Biology and Medicine — Bressler 
Library, University of Maryland. Speakers: B. F. Chow, C. A. Lang and L. Barrows. 
Subject: The Effect of Certain Vitamins on the Biological Activity of B i2 in Vitro and 
in Vivo and The Urinary Excretion of Vitamin B 12 after Oral and Intramuscular 
Administration to Normal Human Subjects (with R. L. Davis and L. C. Conley). 

Dr. Edward J. Herbst of the Department of Biochemistry, School of Medicine 
spoke on New Growth Factors for Hemophilus Parainfluenzas 

Drs. H. C. Johnson, A. E. Walker and C. Marshall of the Department of Neuro- 
surgery, Johns Hopkins University spoke on The Effect of Topical Application of 
Convulsant Drugs on Normal Cortex and Epileptogenic Cortical Foci in the Macaque 
Monkey. 



xii BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

May 4, 1950 

Bressler Library, School of Medicine. Speaker: Dr. R. M. N. Crosby, Department 
of Neurosurgery, School of Medicine. Topic: Studies on the Chemistry of Cerebral 
Pigmentation. 

Contrary to the literature, pigments were found in abnormal spinal fluid which were neither carotine, bilirubin or hemo- 
globin. A method for their extraction and separation from spinal fluid was given along with some of their gross chemical 
characteristics. The pigmentation in Kernicterus, considered in the literature to result from bilirubin, on careful histo- 
chemical studies showed no evidence of bilirubin but was rather lipoidal in nature. A third pigment called "wear and tear" 
pigment appeared to be histochemically similar to that described in experimental animals with dietary cirrhosis (ceroid) 
and identical with that of Vitamin E deficiency. A suggested method of extraction and preliminary purification of the 
pigment was offered. 

June 1, 1950 

Dinner Meeting: Stafford Hotel, Baltimore. Speaker: Dr. R. G. Grenell, Depart- 
ment of Psychiatry, School of Medicine. Topic: Metabolism and Function of the 
Central Nervous System. 

The present state of knowledge relative to the metabolic correlates of neuronal activity, is, to say the least, meager. 
Most of the studies in this field have been performed in vitro, i.e., by the Warburg technique, or by means of such methods 
as arterio-venous differences. The Warburg techniques have the inherent disadvantage of being carried out on tissue re- 
moved from the animal and subjected to slicing, mincing or homogenizing. Under these conditions the same mechanisms 
as the in vivo ones may not necessarily be functioning. The arterio-venous differences, in brain studies, for example, yield 
over-all aspects which tells nothing of the events going on in the different regions of the brain, or in localize i, small groups 
of cells. 

In order to overcome these difficulties, investigations in the intact brain, with two basic technical procedures are being 
pursued. Levels of oxygen tension and relative rates of oxygen consumption are obtained with the oxygen electrode de- 
vised by Davies and Brink (Rev. Sci. Instr. 1942). Chemical control over a small cortical area is produced by local per- 
fusion, through micro-cannulation of a pial arteriole. The standard perfusion fluid is a modified Krebs Solution plus 
gelatine and glucose, equilibrated with 5 per cent CO2 at 38 C. This Solution is adequate to maintain the normal rate of 
oxygen consumption for several hours. 

Problems of anemia, anoxia, narcosis, etc. are being investigated with these methods. In a preliminary series of ex- 
periments carried out with Dr. P. W. Davies, glucose was removed from the perfusate in order to ascertain the effects of 
carbohydrate removal on the cells of the cerebral cortex. Thus far, no change in the rate of oxygen consumption has been 
seen up to 2 hours of perfusion in the absence of glucose. This would imply either that these cells are burning protein or 
fat directly, or that some form of carbohydrate is being synthesized and burned. The possibility of protein playing a major 
role in the functioning of nervous tissue is a most intriguing one, and recent developments in chemistry enable one to set 
up theories of this nature, the validity of which remains for future experiments to determine. 



POST GRADUATE COMMITTEE SECTION 

POST GRADUATE COMMITTEE, SCHOOL OF MEDICINE 



Howard M. Bubert, M.D., Chairman and Director 
Elizabeth Carroll, 
Executive Secretary 

Post Graduate Office: Room 600 

29 South Greene Street 

Baltimore 1, Maryland 



MEDICO-LEGAL SEMINARS 

The Seminar, announced in the October issue of this Bulletin is in its closing days 
as this issue goes to press. The candidates, each selected to attend the Seminar by 
the Heads of their respective Police Department, included senior Homicide Investi- 
gators from the cities of Baltimore, Cumberland, and Hagerstown, and from Anne 
Arundel, Baltimore, Montgomery, and Prince George's Counties. One out-of-state 
officer, representing the Park Police of the United States Department of the In- 
terior, also attended. 

Dr. Richard Ford, Head of the Department of Legal Medicine at Harvard Medi- 
cal School, brought a timely message in his discussion of "Identification in Disaster." 
Using major disasters as examples, including the Coconut Grove Fire, the Texas 
City Explosion, and the Noronic Fire, he outlined a plan for identifying the large 
numbers of dead which might result from an atomic attack. He pointed out that the 
only truly effective means of identification in such a disaster would be for each citi- 
zen to wear a metal identification tag and advocated inclusion of this provision in 
civilian defense planning. In large diasters resulting in many dead persons, certain 
other things also must be done. Before moving the bodies from the scene of the dis- 
aster, they must be tagged, and the tags must state exactly where they were found. 
In order to prevent looting of jewelry and other valuables, which are of great value 
in identification, large closed-body trucks, guarded by adequate police or militia 
should be insisted upon. 

Other out-of-state speakers and their topics were Dr. Milton Helpern, Deputy 
Chief Medical Examiner of New York City, who spoke on "Concealed Murders"; 
Dr. Geoffrey Mann, Chief Medical Examiner of Virginia, whose topic was "The 
Police and Medical Examiner Investigations of Rape"; and Mr. Frank Stratton, 
Police Chemist, Boston City Police, who described "The Latest Advances in In- 
vestigation of Traffic Deaths." 

Student participation through study of the famous "Nutshell Studies of Crime" 
was considered one of the most valuable features of the course. These are amazingly 
accurate scale models of crime lent by their creator, Mrs. Frances G. Lee. The entire 
enterprise was such a success that many leaders in police activities throughout the 
State demanded its repetition, and, consequently, appropriate arrangements will be 
made to repeat it at an early date. 



xiv BULLET IX OF THE SCHOOL OF MEDICINE, U. OF MD. 

HOUSE STAFF TRAINING 

On July 1, 1948, the Obstetric Department of the University of Maryland School 
of Medicine embarked upon a new venture in that it undertook to supply a house 
officer in the allied fields of obstetrics and gynecology to the Peninsula General Hos- 
pital at Salisbury, Maryland. 

There were several reasons why this particular hospital was selected, among them 
being the fact that these two services were already rather well organized and in 
very competent hands. It was felt that the house officers assigned here would receive 
good training and that the interests of a fairly large number of patients would be 
well served. By means of an arrangement with the State Health Department, all 
service obstetric cases in Wicomico County could be admitted to the Peninsula Gen- 
eral Hospital, and, in this way, a considerable amount of clinical material would be 
made available. 

Before undertaking this project, the hospital was surveyed and approved by the 
Committee of Post Graduate Education. The staff of the hospital agreed to abide 
by certain rules and regulations regarding admissions and consultations. The chief 
of the services was made a member of the obstetric staff of the University of Mary- 
land School of Medicine with the rank of Associate in Post Graduate Medicine. The 
chief of services agreed to attend and participate in weekly obstetric conferences of 
the University and, in this way, to familiarize himself with the school's thoughts 
and routines. To carry this same idea further, one of the senior members of the 
obstetric visiting staff travels to Salisbury, Maryland monthly in rotation, and con- 
ducts a conference. 

Each member of the University Hospital staff serves one-fifth of a year at the 
Peninsula General Hospital and four-fifths of a year at the University Hospital. 
The general reaction of the 12 house officers who have served in this capacity is 
that this is a very valuable part of their training. Being the only house officers on 
these services, they have considerable responsibility and, also, are able to perform 
many of the major operations. 

In summary, it would appear that this has proved to be a very successful experi- 
ment, and one which should be continued. 

Report by Dr. Waller D. Wise, Chief of Surgery 

The Annual Report of the Committee on Post Graduate Courses shows that much 
thought has been given to post graduate training, and much has been accomplished. 

There is no question of the need of such training in the State of Maryland and 
there is little doubt that such training is largely the responsibility of the University 
of Maryland. It is unfortunate that there should be confusion in the field best or- 
ganized and the one in which post graduate teaching can be best accomplished, 
namely that of our house officers. This is most evident particularly in surgery and 
some of the specialities. 

The standards have heretofore been set by several conflicting and overlapping 
organizations: The American Medical Association, The American College of Sur- 
geons, and the specialty boards. This confusion has at times caused hardship upon 
men and hospitals. As a result of much complaint, we are now assured that clarifica- 



POST-GRADUATE COMMITTEE SECTION xv 

tion and simplification of requirements is at hand, and that "The Essentials of Ap- 
proved Residencies and Fellowships is being revised. Copies of the revision will be 
available for distribution within the next 30 days."* 

World War II resulted in a lowering of some standards of hospital training and 
interfered with the careers of many men. Some of them lost time and opportunities 
they could not make up before standards were again raised. Now because of war, 
standards will probably have to be changed once more. It will require clear thinking 
and cool judgment to assure justice to the armed forces, civilian hospitals, young 
doctors, and to the public. 

WASHINGTON COUNTY 

The Washington County Medical Society, through its Chairman of Post Gradu- 
ate Courses, Dr. B. B. Kneisley, has requested the Post Graduate Committee of the 
University of Maryland School of Medicine to give another series of six extension 
lectures at the Washington County Hospital, Hagerstown, beginning on November 
14. Dr. John H. Hornbaker is president of the Society, Dr. G. W. LeVan is vice- 
president, and Dr. Ernest H. Poole is secretary-treasurer. The subjects to be in- 
cluded in this year's series are Industrial Health, Neurologic Disorders, Pulmonary 
Diseases, Gastroenterology, Medico-Legal Practice and Office Gynecology. Last year's 
series at Hagerstown was very well attended, and the remarks sent to the Post 
Graduate Office at the close of the season by Dr. Poole, who handled the arrange- 
ments, were very gratifying to the Committee. 

MARYLAND ACADEMY OF GENERAL PRACTICE 

Dr. Lauriston L. Keown is arranging with the Post Graduate Committee for a 
day of lectures to be given in the Gordon Wilson Amphitheatre of the University 
Hospital on December 7, 1950 to the Maryland Academy of General Practice. Lec- 
tures are to be given on the following subjects: Diabetes, allergy, antibiotics, sur- 
gery, anaesthesia, and pediatrics. A luncheon will be served at the hospital to those 
attending. Officers of the Maryland Academy of General Practice are Dr. Charles 
F. O'Donnell, Towson, Md., president; Dr. Irving Baumgartner, Oakland, Md., 
secretary-treasurer; and Doctors E. Paul Knotts, Nathan Needle, and B. B. Kneisley, 
vice-presidents. 

ORTHOPAEDIC RESIDENCY 

In a previous issue of the Bulletin, a plan to initiate the training of orthopaedic 
surgeons was presented whereby integration of three affiliated hospitals (University, 
Baltimore City, and Kernan) was projected. The plan is now in full operation with 
a resident orthopaedic surgeon on each staff, serving for one year in rotation. After 
3 years in these combined services, the physician will have completed training to 
become eligible for examination by the American Board of Orthopaedic Surgery. 
The initiation of this training service is a distinctly progressive step in the field of 
orthopaedic surgery in Maryland and is of immense satisfaction to us. It adds an- 
other link in the cooperative chain of hospitals affiliated with the University of 
Maryland. 

* Personal letter from the American Medical Association. 



ALUMNI ASSOCIATION SECTION 

OFFICERS 

Louis A. M. Kradse, M.D., President 

Vice-Presidents 

Samuel E. Enfield, M.D. Randolph M. Nock, M.D. Fred B. Smith. M.D 

Thurston R. Adams, M.D., Secretary Simon Brages, M.D., Assistant Secretary 

Minette E. Scott, Executive Secretary Charles Reid Edwards, M.D., Treasurer 

Board of Directors 

William H. Triplett, M.D. 
Chairman 



Louis A. M. Krause, M.D. 
Charles Reid Edwards, M.D. 
Thurston R. Adams, M.D. 
Simon Brager, M.D. 
Austin Wood, M.D. 
Wetherbee Fort, M D. 
Albert E. Goldstein, M.D. 
Daniel J. Pessagno, M.D. 



Louis H. Douglass, M.D 



Hospital Council 
Alfred T. Gundry, M.D. 
George F. Sargent, M.D. 
Nominating Committee 
Frank Ogden, M.D. 

Chairman 
Robert F. Healy, M.D. 
Ernest I. Cornbrooks, M.D. 
Frank K. Morris, M.D. 
David Tenner, M.D. 



Alumni Council 



Library Committee 

Milton S. Sacks, M.D. 

Representatives to General Alumni 
Board 

John A. Wagner, M.D. 
Thurston R. Adams, M.D. 
William H. Triplett, M.D. 

Representatives, Editorial Board, 
Bulletin 

Harry C. Hull, M.D. 
Albert E. Goldstein, M.D. 
Louis A. M. Krause, M.D. 

(ex-officio) 
Lewis P. Gundry, M.D. 



The names listed above are officers for the term beginning July 1, 1950 and ending June 30, 1951. 



PROGRESS 

It will doubtless be gratifying to our Alumni to know that a continued increase in 
facilities for training and service may be noted at almost every visit to the vicinity 
of Lombard and Greene Streets. The most recent evidence is the new Psychiatric 
unit which is getting well under way in its course of construction. 

This structure is located west of the hospital, to which it will be physically at- 
tached, and when finished, will give our University complete occupancy of the blo:k 
bounded by Greene, Lombard, Penn and Redwood Streets. 

We have just reason to be proud of this newest addition, because it will give addi- 
tional opportunity, not only for service in a much neglected field, but also training, 
according to the newer concepts dealing with mental illness. 

The program for full utilization of these new facilities is already in process of 
development and since the Department is organized on a full time basis, should be 
ready in advance of the completed building. 

It not only contemplates broadening the scope of teaching at the undergraduate 
level but also post graduate training, which will make possible the forging of a val- 
uable link between the teaching of psychiatry and its practice, whether that be in 
our state hospital system or privately. 

It is well to remember the criticism that has been heaped upon our state mental 
hospitals in the recent past. Well trained personnel to staff them is our greatest, 
in fact, our only assurance that we shall not be subjected to that ignominy again. 
Our Alumni should get behind this program and give it full support to the end that 
our mentally ill will have the benefit of services fortified by training and experience 



ALUMNI ASSOCIATION SECTION 



and the general public the satisfaction that comes from knowing that a job is being 
well done. 

A chain is only as strong as its weakest link. A school's influence is measured by 
the interest shown and the support given by its Alumni. Let us not be the weak 
link! 

William H. Triplett, M.D., Chairman, Board of Directors 

ALUMNI REUNION DATE SET 

The annual Alumni Day with reunions, the annual banquet, the presentation of 
the annual Alumni Honor Award, and the clinical sessions at the University Hos- 
pital will be held on June 7, 1951. 

While the April, 1951, Bulletin will contain further details of the program and 
special events, attention is called at this early date, so the Alumni might prepare 
in advance by including this date on the Spring calendar. You will note this meeting 
is in close proximity to the American Medical Association meeting which will be 
held at Atlantic City, June 11-15. 

Special honors will be bestowed this year on the members of the class of 1901 who 
will be presented with their honorary life membership cards and certificates of 50 
years of service. The members of the three classes of 1901 are listed below. 



Paul Richard Brown 
Ashby C. Byers 
Richard P. Carman 
Homer E. Clarke 
George H. Costner 
William H. Coulbourn 
Benjamin H. Dorsey 
Norman S. Dudley 
Charles T. Fisher 
Charles W. Gardner 
Robert McC. Glass 



William Clay Abel 
David B. Ackley 
Harry E. Anthony 
Fletcher F. Carman 
John R. Davies 
George H. Dill 
Campbell F. Flautt 
Edgar T. Flint 
Frank A. Glantz 
Louis F. Hamrick 



Charles A. Anderson 
Jacob A. Beer 
J. M. Barry 
Lewis Berlin 



University of Maryland 

Robert Lee Hall 
Albert Scott Harden 
Frank C. Heath 
Edward L. Jones 
Guy W. Latimer 
Walter T. Messmore 
Watson S. Rankin 
William M. Riley 
William R. Rogers 
Thomas S. Tompkins 
Edward D. Weems 

Baltimore Medical College 

Enoch H. Harsh 
Eugene H. Hayward 
Samuel J. Herman 
Myron D. Lipes 
James A. McClung 
Robert F. Morrison 
Lamar C. Oyster 
William W. Scarborough 
Frederick G. Shaul 
Colin R. Weirich 

College of Physicians and Surgeons 

Philip S. Chancellor 
Michael A. Conboy 
A. D. Hays 
Joshua Hilliard 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



Andrew J. Loughman 
Stanley T. Lovvry 
William E. McCurry 
Edwin M. McKay 
John B. McMurray 
Tunis Nunemaker 
Everett M. Pearcy 



John R. Robinson 
Mervin T. Sudler 
S. Dana Sutliff 
Andrew B. Vanderbeek 
Samuel Weinberg 
Edward T. West 
Virgil G. Williams 



Aside from the 50 year classes, reunions are scheduled for the classes of 1906, 
1911, 1916, 1921, 1926, 1931, 1936, 1941, and 1946. 

Class secretaries should contact the office of the Executive Secretary, Mrs. Min- 
ette E. Scott for complete mailing lists and assistance in planning class reunions. 




Dr. Philip Adalman shown with his portrait bust of Dr. Rufus Harti 

New York Times 



-Photo; Wide World - 



ALUMNUS A PRIZE WINNING SCULPTOR 

Dr. Philip Adalman, class of 1931, surgeon, of Jackson Heights, New York has 
not only maintained his active practice but has continued his hobby of sculpture, 
being a member of the Clay Club Art Center since 1936. 

Among his many works is included the portrait bust (see illustration) of Dr. Rufus 
Hartill, Assistant Superintendent of the (New York) City Public School System, 
which took first prize in the Physicians' Art Section of the American Medical Asso- 
ciation. 

NOMINATION FOR ALUMNI HONOR AWARD— 1951 

During the month of February, the Board of Directors of the Alumni Association 
will meet to nominate the 1951 candidate for the annual Alumni Honor Award, a 
certificate and gold key presented to an outstanding alumnus of the University of 



ALUMNI ASSOCIATION SECTION xix 

Maryland, Baltimore Medical College or College of Physicians and Surgeons who, 
through "outstanding contribution to medicine and service to mankind" has been 
deemed worthy of this nomination. 

If you know of any alumnus who might merit this nomination, please submit his 
name to Dr. Thurston R. Adams, Secretary of the Medical Alumni Association, Uni- 
versity Hospital, Baltimore 1, Maryland. All nominations will be given careful 
consideration by the Board. 

In the past three years the Honor Award has been presented to the following: 
W. Wayne Babcock, P & S, class of 1893 — Professor Emeritus of Surgery, Temple 

University. 
Nolan D. C. Lewis, class of 1914 — Professor of Psychiatry, College of Physicians 

and Surgeons, Columbia University. 
Arnold D. Tutile, class of 1906, Col., M.C., USA (ret'd)— Medical Director, United 
Airlines. 

Heads S. & D. Blood Donor Center 

Dr. Robert E. Bauer, class of 1946, has been named Medical Director of the Sharp 
and Dohme Blood Donor Center, 702 E. Baltimore Street, Baltimore. This announce- 
ment was made recently by Dr. J. E. Schneider, Director of Biologic and Sterile 
Pharmaceutic Production. 

A graduate of Johns Hopkins University in 1943, Dr. Bauer received his doc- 
torate from the University of Maryland School of Medicine in 1946 and served his 
internship from 1946-47 at the University Hospital, Baltimore. 

From 1947-48 he was Assistant Resident at the same hospital and from 1948-49 
he served in two capacities — as Plant Physician at the Glenn L. Martin Company 
in Baltimore and Assistant in Pathology at the University of Maryland School of 
Medicine. He completed his Residency in Medicine at the University Hospital July 1, 
1950. 

CORRESPONDENCE 

September 4, 1950. 

Just received the July Bulletin and must say I enjoy it very much. I note with 
regret that Dr. Frank Crouch has passed away, as well as Dr. Thomas Tierney and 
Dr. Lloyd Noland. The latter played on the football team with me at B.M.C. in 
1899 and 1900. 1 graduated from B.M.C. with the class of 1901 and next year I want 
to go back to Baltimore and see if any of the old boys are still living. I retired four 
years ago and have not been in very good health since but hope to be able to make 
the trip at the next graduation. 

In view of this, may I ask if there will be any celebration for the 50 year men and 
when? Dr. Harry Anthony of Moravia, New York will probably join me at the time, 
as he was in my class. 

Another thing, I have tried to find out is about my old fraternity. I was a charter 
member of Phi Chi and I believe this fraternity has since affiliated with some other 
fraternity. Can you tell me if this is correct and if the fraternity is still at the Univer- 
sity of Maryland? I see that my old professor, Dr. Rowland, is still living and would 
like to write him but do not know where to write him. Can you give me his address? 



xx BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

I know it is a long time before Spring but I want something to look forward to. 
It is asking a good deal for me to expect people as busy as you all are to write me 
but I am very anxious to get these things cleared up. 
Thanking you in advance, I am 

Very fraternally yours, 

M. D. Lipes, class of 1901 B.M.C. 

June 7, 1950. 
"Thank you" and "appreciate" are inadequate expressions of my feelings regard- 
ing the handsome Fifty Year Certificate. 

Such a gesture is a grand one. The Alumni's thoughtfulness means a great deal to 
me personally and I am sure it does to all of us who have been privileged to remain 
active and serve humanity for five decades. 
With every good wish, believe me 

Sincerely yours, 

Isaac C. Dickson, class of 1897 
3055. West North Avenue, 
Baltimore, Maryland 

May 29, 1950. 
Gentlemen: 

Enclosed is my check for $5.00 for next year's dues. I would like to express my 
admiration for the fine job that has been done with the Bulletin. 

Sincerely yours, 

William I. Wolff, Class of 1940 

2 Horatio Street 

New York 14 New York 

May 23, 1950. 
Will you please convey to the officers of the Association my thanks for the fifty 
year Alumni certificate received by me a few days ago. I prize it greatly and shall 
always appreciate having received it. 

I retired from active practice the first of the present month but shall always be 
interested in the progress of my Alma Mater. 

Sincerely yours, 

Richard J. Turk, Class of 1898, B.M.C. 

May 20, 1950. 
Allow me to thank you for the beautiful and attractive certificate you sent me 
several weeks ago. I appreciate it very much. Please convey to the other members of 
your committee my thanks. 

With kindest regards and best wishes, I am 

Yours sincerely, 

R. W. Love, Class of 1897, B.M.C. 
Moorefield, Virginia 



ALUMNI ASSOCIATION SECTION 



ITEMS 



Dr. Kenneth L. Zierler, class of 1941, is now serving as Assistant Professor of 
Environmental Medicine at Johns Hopkins School of Hygiene and Public Health 
in Baltimore. Dr. Zierler recently reported on his work concerning the effects of vita- 
min E on the carbohydrate metabolism of muscle. 

Dr. C. G. Warner, class of 1928, Pathologist at the Baltimore City Hospitals, 
was recently elected Vice-president of the Maryland Society of Pathologists. 

Dr. Frank Ayd, Jr., class of 1945, was recently the speaker at the Detroit (Michi- 
gan) First Friday Club. 

Dr. Wilbur S. Brooks, class of 1938, is now Chief Radiologist at the University 
of Syracuse, Syracuse, New York. 

Dr. Donald E. Fisher, class of 1947, until recently an Associate in Pathology 
at the School of Medicine, has been commissioned in the United States Public 
Health Service and assigned to the Communicable Disease Center at Chamblee, 
Georgia. 

MAYO CLINIC APPOINTMENTS 

Dr. James S. Hunter, Jr., class of 1941, who recently completed his Fellowship 
in Gynecology and Obstetrics at the Mayo Clinic has been certified by the American 
Board of Obstetrics and Gynecology. Dr. Hunter has been appointed to the staff of 
the Mayo Clinic in the section on Obstetrics and Gynecology. 

Dr. John Spittell, class of 1949, now Assistant Resident in Medicine at Mercy 
Hospital, Baltimore, has been appointed Fellow in Medicine at Mayo Clinic, effec- 
tive July 1, 1951. 

APPOINTED ASSISTANT PROFESSOR AT CORNELL 

Dr. Aaron Feder, class of 1938, has recently been appointed Assistant Professor 
of Clinical Medicine at the Cornell University Medical College. 

Dr. R. Adams Cowley, class of 1944, is now in his second year as Senior Clinical 
Instructor in the Department of Thoracic Surgery at University Hospital, Ann 
Arbor, Michigan. 

Dr. Maurice Feldman, Jr., class of 1944, was one of the speakers at the 15th 
Annual Convention of the National Gastroenterological Association held at the 
Hotel Statler, New York City, June 9 to 11, 1950. 

Dr. James Stanley Hunter, class of 1941, was recently awarded the degree of 
Master of Science in Obstetrics and Gynecology at the Commencement exercises of 
the University of Minnesota. 



xxii BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

Dr. Walter Stevenson, class of 1906, B.M.C., of Quincy, Illinois, President of the 
Illinois State Medical Society, was the author of a paper entitled The Practice of 
Medicine — A Priceless Heritage, delivered at the annual meeting of the Illinois State 
Medical Society at Springfield, Illinois on May 23, 1950 and published in the Illinois 
Medical Journal June, 1950. 

Dr. Raymond C. V. Robinson, class of 1940, was recently awarded the degree of 
Master of Medical Science at the University of Pennsylvania. 

Dr. Robert Gardner, class of 1947, has been appointed to a three year residency 
at Dr. Cole's Clinic in Cleveland. 

Dr. Robert C. Duvall, Jr. class of 1947, formerly of the Department of Derma- 
tology at the School of Medicine has recently been appointed to the Department of 
Pathology at the University of Tennessee School of Medicine. 

Dr. George C. Rogers, class of 1943, is now engaged in the practice of Gynecology 
and Obstetrics at 1 Catawba Street, Spartanburg, South Carolina. 

Dr. William H. Triplett, past President and present Chairman of the Board of 
Directors of the Medical Alumni Association has recently been named President of 
the 29th Division Association. 

Dr. J. Morris Reese, Associate Professor of Obstetrics was recently elected District 
Governor of the 267th District Rotary International. On June 21, 1950, Dr. Reese 
conducted a Panel Discussion on Medicine at the District Rotary International 
Convention which was attended by medical representatives from all over the world. 



FRATERNAL NEWS SECTION 







NU SIGMA NU 

The Spring formal dance will be held in the ballroom 
of the Stafford Hotel, Charles and Madison Streets, 
Baltimore on April 7, 1951, beginning at 9 P.M. 

A series of smokers designed as an orientation course 
for new medical students has been in progress during 
the year. Members of the Alumni including Drs. 
Mech, Wagner, Savage and Hull have addressed the 
group. 

ANNUAL ALUMNI BANQUET 

The annual Alumni banquet of Nu Signa Nu will be held on February 18, 1951 
at the Nu Signa Nu House, 922 St. Paul Street, Baltimore. Note this date on your 
calendar. Details will follow. 

For his work in the use of cortisone in rheumatoid arthritis, Dr. Philip S. Hench 
of the Mayo Clinic, Rochester, Minnesota was recently awarded the 1950 Nobel 
prize for medicine. Dr. Hench is a member of Nu Sigma Nu. Dr. Erland H. Hed- 
rick, class of 1917, is now serving his third term in Congress as the Representative 
of the Sixth District of West Virginia. Dr. Raymond J. Dempsey, class of 1948 is 
now in his Residency in Dermatology at the University Hospital, Ann Arbor, Michi- 
gan. Dr. Norman T. Kirk, class of 1910 is at present residing at Montauk, N. Y. 

PHI BETA PI 

The year 1951 marks the first year since 1940 that a Phi 
Beta Pi has graduated from the School of Medicine. The active 
membership of the Chapter has now grown to 30, with 25 new 
pledges awaiting initiation. 

Dr. Eduard Uhlenhuth, Professor of Anatomy, was the 
speaker at the opening smoker, his topic being "The Purpose 
of a Medical Fraternity." 

Plans for the future include two smokers, details of which 
will be announced by letter. The open forums conducted last 
year will be continued. 
The Chapter has organized a library which is slowly growing. Alumni of Phi Beta 
Pi are solicited for contributions of books and journals. The Chapter also solicits 
donations of furniture for the Chapter Rooms or donations earmarked for that pur- 
pose. Remember the mailing address of Phi Beta Pi is care, the school of Medicine. 
All inquiries will be promptly acknowledged. 




OBITUARIES 

DR. ELMER CLAY KEFAUVER 




Dr. Elmer Clay Kefauver, class of 1891, died July 27, 1950 at the Frederick 
Memorial Hospital, Frederick, Maryland, of heart disease, aged 82. 

He was born at the old Kefauver homestead in Middletown Valley, Maryland, 
the son of Richard C. and Laura Toms Kefauver. 

He attended the old Middletown Academy and later graduated from Franklin 
and Marshall College. After his graduation he began studying under the late Dr. 
J. E. Beatty and then entered the University of Maryland School of Medicine 
graduating in 1891. 

Soon after his graduation he entered practice at Thurmont, Maryland, remaining 
until 1923 when he was made County Health Officer for Frederick County (Mary- 
land). In this capacity he served for 24 years, 23 of them also as Health Officer of the 
city of Frederick. He retired from both appointments in 1947. 

In 1892 he married Miss Mary Alice Atlee. Always active in politics and fraternal 
affairs, for a number of years he was a member of the Frederick County Board of 
Education. 

DR. EDWARD DORSEY ELLIS 

Dr. Edward Dorsey Ellis, B.M.C., class of 1890, aged 81, died in Baltimore on 
June 22, 1950. 



OBITUARIES xxv 

The son of John and Emma Ellis, he received his education in the public schools 
of Baltimore and following his graduation from Medical School continued his studies 
at the Johns Hopkins Medical School, then entered practice with his uncle Dr. 
R. H. P. Ellis. He continued in general practice for over 25 years retiring in 1910. 

DR. HERMAN B. SHEFFIELD 

Dr. Herman B. Sheffield, class of 1895, aged 79, died on March 17, 1950 of arterio- 
sclerosis. 

Following his graduation from Medical School he became associated with the 
Yorkville Dispensary and Hospital for Women and Children from 1898 to 1912, 
along with several additional hospital appointments. In 1905 he was appointed In- 
structor in Diseases of Children at the New York Post Graduate Hospital. Dr. 
Sheffield was a Fellow of the New York Academy of Medicine and a member of the 
American Medical Association and New York State Medical Society. He was a 
founder of the Zeta Beta Tau Fraternity and was the author of five books on diseases 
of children including two text books. In 1914 he won the Alverengo prize of the College 
of Physicians of Philadelphia and in 1920 the Merritt H. Cash prize of the New 
York State Medical Society. In 1 930 he retired from practice because of failing vision 
but continued his literary activities with the writing of lyric poetry. 

DR. HARRY GALLISON PRENTISS 

Dr. Harry Gallison Prentiss, class of 1881, died at his home in Baltimore on No- 
vember 24, 1950, aged 92. He was born in Baltimore on May 2, 1858. After his gradu- 
ation from the School of Medicine, he began the practice of general medicine in the 
Waverly-Govans area and continued his active participation in medical affairs up 
until a few years ago. 

Dr. Prentiss was one of the few living physicians who began his career on horseback 
and saw the evolution of many of the milestones in medical science 

Brown, Edward W., Washington, Va.; P & S, class of 1887; aged 90; died, July 2, 

1950. 
Burns, Robert Francis, Fitchburg, Mass.; B.M.C., class of 1908; aged 66; died, June 

5, 1950, of coronary disease. 
Cannon, Martin Loeb, Washington, D. C; class of 1932; aged 48; died, June 26, 

1950, of coronary disease. 
Carter, Paul Conway, Madison, N. C; class of 1916; aged 60; served during World 

Wars I and II; died, March 27, 1950, of hepatitis. 
Devlin, Peter C, Lynn, Mass.; B.M.C., class of 1902; aged 72; died, July 25, 1950, 

of coronary thrombosis. 
Dunlap, William Verner, St. Petersburg, Fla.; P & S, class of 1897; aged 75; died, 

June 5, 1950, of cerebral thrombosis. 
Ewald, George Latrobe, Baltimore, Md.; class of 1900; aged 75; died, July 14, 1950. 
Fleming, Thomas F., Exeter, Pa.; B.M.C., class of 1901; aged 76; died, May 6, 1950, 

of cerebral hemorrhage. 
Fox, Lorah O., Ansted, W. Va.; P & S, class of 1910; aged 60; died, July 6, 1950, of 

heart disease. 



xxvi BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

Glidden, Edson W., Worcester, Mass.; class of 1907; aged 65; served during World 

War I; died, April 26, 1950, of coronary occlusion. 
Gore, Michael Alvord, Granby, Colo.; class of 1918; aged 56; died, April 10, 1950. 
Harper, James Clarence, Greenwood, S. C.; class of 1902; aged 77; died, July 17, 

1950. 
Hart, Henry D., Genesee, Pa.; B.M.C., class of 1893; aged 89; died, April 18, 1950, 

of cerebral hemorrhage. 
Hines, Frank Brown, Chestertown, Md.; P & S, class of 1904; aged 68; served during 

World War I; died, March 28, 1950, of carcinoma of the right lung. 
Hood, M. Bowman, Baltimore, Md.; B.M.C., class of 1900; aged 72; died, May 13, 

1950, of heart disease. 
Iseman, Everett, Savannah, Ga.; class of 1909; aged 65; served during World War 

T; died, September 3, 1950, of coronary thrombosis. 
Jefferson, Benjamin Lafayette, Grand Junction, Colo.; class of 1893; aged 78; died, 

July 21, 1950. 
Kefauver, Elmer C, Frederick, Md.; class of 1891; aged 82; died, July 7, 1950. 
Kelly, Clyde Ernest, Vandergrift, Pa.; class of 1929; aged 49; died, August 30, 1950, 

of heart failure. 
King, Isaac Newton, Prince Frederick, Md.; B.M.C., class of 1897; aged 76; died, 

June 25, 1950, of carcinoma. 
Kipps, David M., Front Royal, Ya.; P & S, class of 1888; aged 84; died, August 

17, 1950, of coronary thrombosis. 
Kisner, Jacob C, Albuquerque, N. Mex.; P & S, class of 1880; aged 96; died, July 

4, 1950. 
Lanich, Lloyd Jackson, Kingwood, W. Va. ; class of 1915; aged 63; served during 

World War T; died, June 27, 1950, of cerebral hemorrhage. 
LaValle, Irving Howard, Fish's Eddy, N. Y.; B.M.C., class of 1913; aged 68; died, 

August 17, 1950, of carcinoma of the lungs. 
Lavoie, Zenon Annable, Manchester, N. H.; B.M.C., class of 1902; aged 78; died, 

June 1, 1950, of gangrene of the leg, popliteal aneurysm and general arterio- 
sclerosis. 
Law, Thomas F., Washington, D. C, P & S, class of 1906; aged 71; died, June 30, 

1950, of cerebral hemorrhage. 
Lightle, William E., North Berwick, Me.; B.M.C., class of 1894; aged 82; died, May 

1, 1950, of cerebral hemorrhage. 
McKee, John Sasser, Raleigh, N. C; class of 1907; aged 72; served during World 

War I; died, April 22, 1950, of coronary occlusion. 
Norton, James Arthur, Conway, S. C; class of 1903; aged 73; served during World 

War I; died, July 21, 1950, of carcinoma. 
Perkins, Thornton W., Hopkinsville, Ky.; P & S, class of 1900; aged 80; died, April 

10, 1950, of carcinoma of the prostate. 
Reichard, Lewis Nyman, Brownsville, Pa.; P & S, class of 1899; aged 73; died, May 

15, 1950, of embolism and heart disease. 
Richardson, Walter B., Heathsville, Ya.; B.M.C., class of 1895; aged 82; died, Au- 
gust 17, 1950, of carcinoma of the prostate. 



I OBITUARIES xxvii 

Robinson, Francis A., Burlington, Mass.; B.M.C., class of 1894; aged 81; died, 
April 29, 1950, of heart disease. 

Smith, Edward Sanborn, Kirkville, Mo.; class of 1900; aged 75; served during World 
War I; died, July 23, 1950, of cerebral hemorrhage. 

Spalding, William Cullen, Los Angeles, Calif.; P & S, class of 1915; aged 60; died, 
I May 23, 1950, of coronary occlusion. 

Van Poole, Gideon McDonald, Honolulu, Hawaii; class of 1899; aged 73; served 
during World War I; died, April 13, 1950, of carcinoma of the prostate. 

Ward, Jesse Elliott, Robersonville, N. C; class of 1904; aged 67; died, March 23, 
1950, of acute heart failure. 

Warren, David Edward, Passaic, N. J.; P & S, class of 1892; aged 81; died, July 
S 14, 1950. 

Welland, Herman, Rockbridge Baths, Va.; class of 1899; aged 78; died, February 
I 28, 1950. 

Whitaker, Preston W., Long Beach, Calif.; P & S, class of 1908; aged 65; died, re- 
cently, of heart disease and cerebral hemorrhage. 

Wood, Frederick Barton, Elmhurst, N. Y.; B.M.C., class of 1910; aged 67; died, 
June 24, 1950, of heart disease. 



Special Notice on first page of Alumni Section 



Bulletin of 



THE SCHOOL OF MEDICINE 

UNIVERSITY OF MARYLAND 

VOLUME 36 April, 1951 NUMBER 2 

EDITORIAL 

A DOCTOR'S DUTY 

During the past twenty years the average entering medical class has numbered 
6,241. The average graduating class has numbered 5,230. The average loss from 
each class has been 1,011. This gives an attrition rate through the four years of 
medical college of 16.3 per cent. With a current ratio of about one physician for 
every 760 persons but with admitted difficulties arising from unequal distribution 
and continued calls from the Armed Forces for medical personnel, it has been sug- 
gested that the total number of medical graduates should be materially increased 
through the establishment of new schools of medicine. 

Instead of increasing the facilities for students of medicine, it is the opinion of 
many that a more careful survey of the candidates for admission to schools of medi- 
cine, with a resulting lower attrition rate, could increase the number of graduates 
by 750 a year. Consequently, medical educators have turned to the task of ade- 
quately screening the large number of applicants, selecting those men and women who 
are not alone properly qualified but who are oriented to the study of medicine and 
whose college recommendations indicate a high degree of sincerity and motivation. 
This is a tiresome, expensive, and consuming task. However, it produces results. 

The University of Maryland is taking steps to lower this national attrition rate. 
This will mean fewer empty seats in class as a result of failure or withdrawal. This 
means more doctors; more competent doctors. 

The physician's duty to medical education is the recognition and careful guidance 
of competent and purposeful young people during their early education. This is 
particularly applicable to the doctor's son, who, desiring to emulate his father, often 
decides to enter the practice of medicine. Only too often the disappointed alumnus 
is confronted by a knowledge that his efforts to guide his son have been instituted 
too late. Many college faculties have already organized premedical committees who 
will advise students during their college years. The doctor's son finds himself in a 
most fortunate position, having the advice and experience of a father who has 
devoted his life to the practice of medicine. It is therefore prudent that every phy- 
sician who has a son who aspires to follow in his footsteps, begin early to inquire into 
the most minute details of his education by consulting the premedical committee of 
the college where his son will attend, and by securing a copy of the medical school 
catalogue to learn its requirements at the same time. 

Continued careful attention to these details will not only assure a supply of 
competent physicians but will assist those doctors whose sons would follow them 
in the practice of medicine. 

47 



SUGAR .ALCOHOLS— XXVIII. TOXICOLOGIC, PHARMACODYNAMIC AND 
CLINICAL OBSERVATIONS ON TWEEN 80* 

JOHN C. KRANTZ, JR., Ph.D., 1 PERRY J. CULVER, M.D., 2 C. JELLEFF CARR, Ph.D. 1 
and CHESTER M. JONES, M.D., F.A.C.P. 2 

INTRODUCTION 

Malnutrition associated with steatorrhea and a faulty absorption of such fat 
soluble substances as Vitamins A and K has been observed in a number of patients 
with gastro-intestinal tract diseases, such as sprue, pancreatic deficiency, regional 
ileitis, after short-circuiting operations on the small bowel, and following subtotal 
gastrectomy. Restoration of an adequate state of nutrition in these patients often 
taxes the ingenuity and pharmacopeia of the clinician. The magnitude of the loss 
of caloric material in the stools of these patients is illustrated by the fact that; 
whereas, the normal stool fat content is usually less than 4 per cent of ingested fats 
(1), under these disease conditions the fecal lipid content may exceed 40 to 60 per 
cent of the dietary intake of fat (2). 

Jones et al. (3) have shown that the administration of the emulsifying agent Tween 
80 to such patients may produce a dramatic increase in the intestinal absorption of 
fat and vitamin A. Holt has observed a similar effect of Tween 80 in premature in- 
fants (4). Improvement in the absorption of vitamin A by means of the corresponding 
laurate or palmitate (Tween 20 or 40) has been reported by Sobel et al. (5) and by 
May and Lowe (6), although Johnson et al. (7) found the laurate to have no signi- 
ficant effect on fat absorption in low concentrations. Becker et al. (8, 9) have indi- 
cated that Tween 80 may have an effect upon blood chylomicron curves in man. 

In consideration of the possible clinical implications of Tween 80, a survey of our 
knowledge of the toxicology and pharmacodynamics of this emulsifying agent is 
presented. 

THE CHEMICAL AND PHYSICAL NATURE OF TWEEN 80 

Tween 80 is a complex mixture obtained by the rigidly controlled reaction of 20 
mols of ethylene oxide with 1 mol of mixed sorbitan oleates, which are in turn the 
products of the partial esterification of the hexahydric sugar alcohol sorbitol with 
oleic acid. Its typical component is represented by the formula top of page 49. 

It is a lemon to amber-colored viscous liquid, having a faint characteristic odor 
and bitter taste, and forms practically neutral solutions with all proportions of 
water. It is also soluble in alcohol, fats, and vegetable oils, but is insoluble in mineral 
oil. 

* These studies were aided by grants from Atlas Powder Company, Wilmington, Delaware. Tween 
80 is the Atlas trade-mark for polyoxyethylene (20) sorbitan monooleate. This compound is listed, 
in U.S.P. XIV under the name "Polysorbate 80" and is designated "Sorethytan (20) Monooleate" 
by the Council on Pharmacy and Chemistry of the A.M.A. 

1 Department of Pharmacology, School of Medicine, F/niversity of Maryland, Baltimore, Mary- 
land. 

2 Department of Medicine, Harvard F/niversity, and the Medical Service of the Massachusetts 
General Hospital, Boston, Mass. 

48 



KRANTZ, ET AL.— SUGAR ALCOHOLS 



49 



H 



O 



H 



H H 



C- 



c- 



-C— 0— (CH 2 — CH 2 — 0) x — H 

-C— 0— (CH 2 — CH 2 — 0) y — H 

H 



H— C— 0— (CH 2 — CH 2 — 0)— H 

O 

Ho C — — C — C 1 7H34 

where the sum of x + y + z equals an average total of 20. 

As a partial ester of a fatty acid and a strongly hydrophilic polyhydric alcohol 
derivative, Tween 80 is an emulsifying agent and a non-ionic surface active agent; 
a 0.1 per cent solution in water at 25 C. having an interfacial tension of 41 dynes/ cm. 
against air and 8.7 dynes/cm. against a sample of corn oil, compared with 72 and 19.4 
dynes/cm. respectively for distilled water (10, 11). 

EFFECT OF LIPASE 

Being a fatty acid ester, Tween 80 is readily hydrolyzed by pancreatic lipase to 
oleic acid and the corresponding polyoxyethylene sorbitan alcohols. Harrisson (12) 
has shown the rate of lipolysis of this compound to be approximately one-half that 
found for olive oil, in agreement with the data obtained by Gomori (13) on Tweens 
40 and 60, the respective polyoxyethylene sorbitan palmitates and stearates. Simi- 
larly, Archibald (14) has proposed the corresponding laurate as the substrate for the 
determination of lipase activity. 

TOXICOLOGY IN ANIMALS 

Extensive feeding studies in animals have been made with all members of the 
Tween group by Krantz and Carr (11). Among these, they have shown Tween 80 to 
be innocuous for white rats in concentrations of two per cent in their diet for their 
life span, as shown in the accompanying table. Groups of 30 white rats were fed a 
similar concentration of this emulsifying agent through three generations, according 
to the procedure of Carr and Krantz (15). There was no evidence of alteration in the 
fecundity of the first and second generation of rats. The growth patterns of the 
animals in the first, second, and third generations were not significantly affected. 
There was no evidence of gross or histologic damage to the livers and kidneys of rats 
fed Tween 80 in the three generations. Likewise, the feeding of 1 gram per day to 
two Macacus rhesus monkeys for 10 months produced no significant histologic 
visceral changes. 

Acute toxicity studies were also conducted on the white rats (11). Animals weigh- 
ing from 120 to 200 grams tolerated Tween 80 orally in doses of 
symptoms. When these animals were sacrificed three days late 



It'* 



^ 



LIBRARY ° 



Feucdad 1813 



% 



OL 



OF M 



&o\ L 



r\\ 



50 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



liver showed no damage. Injected intraperitoneally in undiluted form, the compound 
killed by respiratory paralysis. The LD 50 intraperitoneally for the white rat is 
between 8 and 9 cc. per kilogram of body weight. Hopper and coworkers (16) have 
reported the LD 50 for Tween 80 in mice to be greater than 25.0 gms. per kilogram 
(per os, 72 hours observation) and 5.8 gm./Kg. via intravenous injection (24 
hours observation). 

In experiments with mice fed 1 per cent of Tween 80 over a two-month period, 
Dubos (17) reported that the addition of the emulsifier to the basal diet did not 
affect the weight, mortality and susceptibility of the animals to experimental tuber- 
culosis, or to the therapeutic effects of penicillin after the experimental infection. 

Kellner et al. (18) fed rabbits 10 cc. of Tween 80 daily for 20 weeks and injected 
unspecified amounts intravenously for 8 to 14 weeks (19) with apparently no unto- 
ward effects. 



TABLE 1 

Summary of Life Span (2-year) Study of White Rats Fed 2% of Tween 80 in a Basal 

Diet of Purina Chow 



NUMBER OF ANIMALS 



At start 

Autopsied in progress. . . 

Accidental deaths 

Net carried 

Cause of deaths 

a. Unknown 

b. Middle ear infection 
Surviving at 24 months. . 
Surviving at 24 months, c 
Survivors autopsied 



EXPERIMENTAL 



Male Female Total 



15 
4 
1 

10 

5 
2 
3 
30 
3 



15 
3 
2 

10 

6 
1 

3 

30 

3 



30 

7 

3 

20 

11 
3 
6 

30 
6 



Male Female Total 



15 

2 

1 

12 

7 
4 
1 



15 
1 
1 

13 

6 
4 
3 
23 
3 



30 

3 
2 

25 

15 
8 
4 

16 
4 



EFFECT ON BLOOD PRESSURE 

Of special interest is the depressing effect of intravenously administered Tween 
80 upon the blood pressure, an effect which varies from species to species (20). 
When a 5 per cent aqueous solution of this emulsifier is injected in doses of 1 cc. per 
kilogram of body weight into the veins of cats, rabbits, and Macacus rhesus monkeys, 
there is a slight and transient fall in blood pressure. On the other hand, dogs and 
other canine species (21) exhibit an idiosyncratic reaction to intravenous Tween 80 
by a prolonged depressor response. This fall in blood pressure was never elicited 
by the oral administration of the Tween emulsifiers. Moreover, when only the 
polyoxyethylene sorbitan portion of the ester obtained by saponification was in- 
jected intravenously, there was no depressor response even in the dog. This would 
seem to indicate that the whole Tween molecule is necessary for any effect upon 
blood pressure. The idiosyncratic response of the canine family to the intravenous 
administration of all members of the Tween group, regardless of the nature of the 
esterifying fatty acid, appears to be caused by the release of some histamine-like 
substance (20, 22, 23). The reaction has not been obtained in man (20). 



KRANTZ, ET AL— SUGAR ALCOHOLS 51 

EFFECT ON BLOOD CELLS 

Tween 80, in common with other surface active agents, may be shown in vitro 
to have some hemolytic effect, as follows: 

The freshly shed, defibrinated blood of the dog ^as used. Solutions of the sub- 
stance in various concentrations in physiological salt solution were prepared. To 10 
cc. volumes of these solutions, 0.1 cc. blood was added, mixed, and observed at 37° 
and 26°C, respectively. The results are shown in Table 2. 

CLINICAL OBSERVATION AND PHARMACODYNAMICS IN MAN 

Evidence of beneficial effects of Tween 80 upon the intestinal absorption of fat and 
vitamin A in some cases (3) has prompted two of the authors (C. M. J. and P. J. C.) 
to prescribe this emulsifying agent to more than 100 patients at the Massachusetts 
General Hospital during the last 4 years. This group of patients, of approximately 
equal sex distribution and ranging in age from 5 to 72 years, consists of 10 subjects 
who have taken Tween 80 for 3-4 years, 17 for 2-3 years, 19 for 1-2 years, and the 
remainder for less than 1 year. The usual dose of Tween 80 has been 4.5 to 6 grams 
per day; one man was given 15.0 grams per day for several months. The large body of 
clinical and laboratory data collected during the course of the study clearly indicates 
the harmlessness of Tween 80 in the human upon continued oral ingestion of the 
prescribed amounts. 

Clinical observations of these patients during hospitalization or at periodic office 
visits demonstrated a complete absence of toxic symptoms referable to the digestive 
or urinary systems. A rare patient had an occasional soft stool. Inquiry as to the 
presence of other possible symptoms showed a complete lack of headache, dizziness, 
muscular or joint aches, itching, weakness, cardiovascular complaints, loss of ap- 
petite, or any other manifestation that could be attributed to the ingestion of Tween 
80. Blood pressures remained unchanged. In no case was there a significant loss of 
body weight, while many malnourished patients gained weight during the period of 
continued consumption of the emulsifying agent. 

Routine laboratory tests showed that there was no detrimental effect upon the 
hematopoetic system. Kidney functions remained normal according to periodic 
examinations of the urine. The concentrating powers of the kidneys remained un- 
impaired. In no case was there albuminuria resulting from the administration of 
Tween 80, and. the absence of formed elements in urinary sediments was evidence of 
a lack of irritation of the kidney parenchyma by this substance. There were no in- 
creases in the blood non protein nitrogen. Repeated batteries of liver function tests, 
including the cephalin flocculation, prothrombin time, bromsulfalein retention, and 
serum albumin and globulin levels showed that the emulsifying agent did not disturb 
the functions of the liver. Blood calcium levels remained normal or increased from a 
low level, and the blood phosphorus levels remained normal. 

Of considerable interest is the fact that during this 4 year period of Tween 80 
administration, the blood cholesterol levels have shown no significant increase be- 
yond the normal range. The blood vitamin A levels also remained within the normal 
range, or rose to a normal level if they were initially below normal. The following 
case report is representative of the group of patients who have ingested Tween 80 
for long periods of time: 



52 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



Mrs. R. W., a 37 year old widow, had a partial resection of the small and large 
bowel in 1942 because of ileocolitis. Following operation, there was diarrhea and 
gradually increasing malnutrition. Her weight dropped from a normal of 53 Kg. in 
1942 to 38.8 Kg. in March, 1947. On March 12, 1947, the patient began to take 1.5 
gm. Tween 80 with her meals for one month. The administration of the emulsifying 
agent was discontinued for one month and then resumed on May 27, 1947, at a 3.0 
gm. level for one month. It was again discontinued for the following month and 
resumed on July 25, 1947, with a daily dose of 4.5 gms. The patient has continued 
to take either 4.5 or 6 grams of Tween 80 per day ever since with the exception of an 

TABLE 2 
Hemolysis Studies 







MINUTES FOR 90% HEMOLYSIS 


TWEEN 80% 








37°C 


26°C 


10 


33 




59 


5 


46 




80 


1 


76 




100 


0.1 


105 




270 


0.01 


none 




none 



TABLE 3 

Urine and Blood Examinations 





URINE 


BLOOD 




Sp. Grav. 


Alb. 


Sugar 


Sed. 


NPN 
mgms. % 


Hgb. 

gms. % 


WBC 


3/ 7/47* 


1.026 











25 


9.3 


4.100 


9/25/47 


— 


— 


— 


— 


— 


12.6 


5,450 


12/18/47 


1.032 











19 


— 


6,100 


5/27/48 


1.028 








occ. WBC 


15 


13.0 


— 


10/13/48 


1.020 








rare WBC 


22 


14.8 


13,100 


12/20/49 


— 


— 


— 


— 


24 


— 


— 


2/17/50 


1.018 











— 


13.0 


9,400 


10/31/50 


— 


— 


— 


— 


20 


13.0 


9,000 



occasional control month, during 1948 and without interruption during the past two 
years. 

At periodic clinic visits she reported gradual improvement in her health during 
this time. Her troublesome diarrhea decreased greatly. At intervals, the patient 
reported dizzy spells, headaches, belching, vomiting, poor appetite, and occasional 
abdominal cramps. These symptoms were present before administration of Tween 
80 and appeared as frequently during the intervals that the patient was not taking 
the emulsifier as when she was. The appearance of these symptoms was usually as- 
sociated with emotional upsets or physical fatigue and could in no way be attributed 
to the ingestion of the emulsifier. There were no other symptoms which might suggest 
a deleterious effect. 



KRANTZ, ET AL — SUGAR ALCOHOLS 



53 



Physical examinations have shown improvement in weight from a low of 38.8 
Kg. in 1947 to 49 Kg. in December, 1950. There has been elimination of the signs of 
malnutrition. Her blood pressures have remained normal, being 110 millimeters of 
mercury systolic and 70 millimeters, diastolic, in December, 1950. General physical 
findings are now normal except for a tender spot in the left lower abdomen. This 
tenderness has always been present since the onset of her illness. 

The patient's laboratory data, summarized in the following tables, indicate that 
Tween 80 has had no deleterious effect upon the liver, kidneys, or blood, and that the 
blood chemistries showed no evidence of pathologic variation. 

TABLE 4 
Liver Chemistries 



DATE 


CEPH. FLOC. 


PROTHROMBIN 

TIME 


BSP 


ALBUMIN 


GLOBULIN 










per cent 


per cent 


3/ 7/47* 


Neg.. 


16/16 


■ — 


3.5 


2.0 


6/24/47 


— 


— 


— 


4.5 


2.3 


9/25/47 


Neg. 


17/17 


— 


4.7 


2.1 


12/18/47 


Neg. 


17/16 


6% 


4.2 


2.3 


5/27/48 


. Neg. 


20/17 


— 


4.2 


2.0 


10/13/48 


Neg. 


20/16 


— 


4.1 


2.8 


12/20/49 


Neg. 


17/18 


— 


4.6 


2.1 


10/31/50 


Neg. 


18/19 


2% 


4.2 


2.6 



TABLE 5 

Miscellaneous Blood Chemistries 



DATE 


VIT. A 


CAROTENE 


CHOLEST. 


CHOLEST. ESTERS 


ca 


p 




l.V.I cc. 


I.U./cc. 


mgs.% 


mgms.% 


mgms.% 


mgms.% 


3/ 7/47* 


0.8 


0.6 


— 


— 


8.3 


3.7 


6/24/47 


1.2 


0.6 


133 


94 


8.2 


3.3 


12/18/47 


0.6 


0.5 


130 


104 


8.0 


3.7 


5/27/48 - 


0.6 


0.6 


153 


84 


8.0 


3.6 


10/13/48 


1.3 


0.6 


188 


108 


9.4 


3.6 


12/20/49 


— 


— 


166 


116 


9.4 


— 


10/31/50 


0.7 


0.4 


135 


85 


8.8 


3.0 



* Before administration of Tween 80. 

In addition to the above described clinical and laboratory observations, special 
studies were carried out on a few patients to see if Tween 80 might produce other 
measurable changes in man. Five persons, who were on constant daily food intakes 
in the metabolic ward, were subjected to metabolism tests before and during the 
administration of the emulsifying agent. There was no evidence of alteration in 
metabolic rate as a result of the taking of Tween 80. Table 6 shows the metabolic 
rates in a typical case. 

An attempt was also made to obtain information about the absorption and utili- 
zation of water soluble vitamins while patients were ingesting Tween 80. Indirect 
evidence of no effect was obtained by determining the urinary excretion of water 



54 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



soluble vitamins before and during the administration of the emulsifying agent to 9 
persons who were receiving a constant food and vitamin intake while in our metabolic 
ward. The findings in a typical case are shown in Table 7. 

FATE OF TWEEN 80 IN MAN 

It has been possible to determine the ethoxyl value of the urine and stools of the 
subjects fed Tween 80 and thereby to ascertain the amount excreted of at least the 



TABLE 6 

Metabolic Rates in Case D. D., 48 year old female 





2/26/48 

BEFORE TWEEN 80 


4/22/48 

during administration tween 80, 

(6.0 gms./day) 


7 a.m. 

10 a.m. 

2 p.m. 

4 p.m. 


-20 

-3 
+3 

+ 7 


-25 

+4 
-3 

+ 7 



TABLE 7 

The Urinary Excretion of Water Soluble Vitamins Before and During the Administration of Tween 80 

4.5 grams per day, to a 61 year old man 



PERIOD 




URINARY EXCRETION IN PER CENT OF INTAKE 




Thiamin 


Riboflavin 


Niacin 


Ascorbic Acid 


Before 

During 


9.6 
11.3 


23.7 
30.3 


31.4 
46.2 


21.6 
30.9 



TABLE 8 
Experimental Recovery of the Polyoxyethylene Moiety from the Urine and Stools of Four Subjects 



SUBJECT* 


FEEDING PERIOD 
% EXCRETED IN 


POST-FEEDING PERIOD 
% EXCRETED IN 


TOTAL 
EXCRETION 




Urine 


Stool 


Urine 


Stool 




R. S 

F. V 


3.8 
4.0 

3.8 

5.8 


85.0 
80.3 
80.6 
83.4 


0.1 
0.1 
0.1 
0.1 


8.9 
13.4 
17.8 

7.0 


% 

97.8 
97.8 


D. D 


102.3 


E. R 


96.3 



* Each ingested 54 gms. of Tween 80 during a 12-day period. 

polyoxyethylene portion of the polyoxyethylene sorbitan moiety from the Tween 80 
ingested. Details of this study will be reported elsewhere (24). The data summarized 
in Table 8 show that, within the limits of error of the chemical method of analysis, 
there has been complete excretion of the polyoxyethylene groups from the human 
body. 

Qualitative analysis of the urine failed to show the presence of any fatty acid. 



KIL4NTZ, ET AL— SUGAR ALCOHOLS 55 

This fact plus the in vitro evidence of hydrolysis of polyoxyethylene sorbitan mono- 
oleate (Tween 80) by pancreatic lipase suggests that the small percentage of the 
polyoxyethylene groups excreted in the urine results from hydrolysis of Tween 80 
in the intestine and the subsequent absorption of a small amount of the hydrolysate, 
with the remaining approximately 95 per cent of the polyoxyethylene moiety ac- 
counted for in the stool. 

SUMMARY 

1. The chemical, physical, and certain biochemical properties of the non-ionic 
emulsifying agent polyoxyethylene (20) sorbitan monooleate (Tween 80) are de- 
scribed. 

2. Extensive animal studies have shown that Tween 80 is innocuous when given 
orally in relatively high doses. 

3. The oral administration of Tween 80 in doses of 4.5-6 grams per day to more 
than one hundred human subjects for periods up to four years has been unattended 
by any clinical evidence of ill effect, alteration of metabolic rate and blood chemis- 
tries, change in excretion of water soluble vitamins, or evidence of damage to liver, 
kidneys, and hematopoetic system. 

4. Analysis of the urine and stools of subjects who have ingested Tween 80 showed 
complete elimination of the polyoxyethylene moieties of the emulsifier from the 
human body. Approximately five per cent of the polyol was excreted in the urine and 
95 per cent in the stool. 

5. Tween 80 appears to be completely harmless for human ingestion in amounts of 
at least 6.0 grams per day as judged from the available data and the four year period 
of observation. 

REFERENCES 

1. Wollaeger, E. E., Comfort, M. W. and Osterberg, A. E.: Total solids, fat and nitrogen in 

the feces. TIL A study of normal persons taking a test diet containing a moderate amount of 
fat; comparison with results obtained with normal persons taking a test diet containing a 
large amount of fat, Gastroenterology 9: 272, 1947. 

2. Culver, P. J. and Jones, C. M.: Unpublished data. 

3. Jones, C. M., Culver, P. J., Drummey, G. D. and Ryan, A. E. : Modification of fat absorption 

in the digestive tract by the use of an emulsifying agent, Ann. Int. Med. 29: 1, 1948. 

4. Holt, L. E., Jr.: Unpublished data reported in Ref. 11, p. 34, 1949. 

5. Sobel, A. E., Besman, L. and Kramer, B.: Vitamin A absorption in the newborn, A. J. Dis. 

Child. 77: 576, 1949. 

6. May, C. D. and Lowe, C. U.: The absorption of orally administered emulsified lipid in normal 

children and in children with steatorrhea, J. Clin. Invest. 27: 226, 1948. 

7. Johnson, A. L., Scott, R. B. and Newman, L. H.: "Tween 20" and fecal fat in premature in- 

fants, A. J. Dis. Child. 80: 545, 1950. 

8. Becker, G. H., Meyer, J. and Necheles, H.: Fat absorption and atherosclerosis, Science 110: 

529, 1949. 

9. Becker, G. H., Meyer, J. and Necheles, H.: Fat absorption in young and old age, Gastro- 

enterology 14: 80, 1950. 

10. Atlas surface active agents, Atlas Powder Company, Wilmington, Delware, 1950. 

11. The nature, suitability for and uses in foods and pharmaceuticals of sorbitol, mannitol and 

emulsifiers, Atlas Powder Company, Wilmington, Delware, 1949. 



56 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

12. Harrisson, J. W. E.: Unpublished data reported in record of bread standards hearing, Federal 

Security Agency, Washington, D. C, p. 16798, 1949. 

13. Gomori, G.: The microtechnical demonstration of sites of lipase activity, Proc. Soc. Exper. 

Biol. & Med. 58: 362, 1945. 

14. Archibald, R. M.: Determination of lipase activity, J. Biol. Chem. 165: 443, 1946. 

15. Carr, C. J. and Krantz, J. C, Jr.: Effect of feeding calcium arabonate in diet of rats for suc- 

cessive generations, Proc. Soc. Exper. Biol. & Med. 59: 54, 1945. 

16. Hopper, S. S., Htjlpieu, H. R. and Cole, V. V.: Some toxicological properties of surface-active 

agents, J. A. Pharm. Assn., Sci. Ed. 38: 428, 1949. 

17. Dubos, R. J.: Unpublished data, reported in record of bread standards hearing, F.S.A., Wash- 

ington, D. C, p. 15672, 1949. 

18. Kellner, A., Correll, J. W. and Ladd, A. T. : Effect of polyoxyalkylene sorbitan monooleate 

on blood cholesterol and atherosclerosis in cholesterol-fed rabbits. Proc. Soc. Exper. Biol. & 
Med. 67: 25, 1948. 

19. Ladd, A. T., Kellner, A. and Correll, J. W.: Intravenous detergents in experimental athero- 

sclerosis, with special reference to the possible role of phospholipids, Federation Proceedings, 
8: 360, 1949. 

20. Krantz, J. C, Jr., Carr, C. J., Bird, J. G. and Cook, S.: Pharmacodynamic studies of poly- 

oxyalkylene derivatives of hexitol anhydride partial fatty acid esters, J. Pharmacol. & Exper. 
Therap. 93: 188, 1948. 

21. Krantz, J. C, Jr., Carr, C. J., Bubert, H. M. and Bird, J. G.: Drug allergy in the canine 

family, J. Pharmacol. & Exper. Therap. 97: 125, 1949. 

22. Ivy, A. C, Tanturi, C. A., Hernandez, R. and Baroso, E.: Urticarial reaction induced in the 

dog by intravenous injection of sorbitol monolaurate, Arch. Dermatology & Syphilology, 58: 
659, 1948. 

23. Grossman, M. I. and Robertson, C. R.: Stimulation of gastric secretion by urticariogenic 

wetting agent (Tween 20) and its inhibition by benadryl, Proc. Soc. Exper. Biol. & Med. 68: 
550, 1949. 

24. Culver, P. J., Wilcox, C. S., Jones, C. M. and Rose, R. S.: In press. 



A METHOD OF DIVIDING INTRACARDIAC STRUCTURES WITHOUT 
OPENING THE HEART CHAMBERS*! 

ROBERT S. PENTON, M.D. and OTTO C BRANTIGAN, M.D. 
DIVISION OF INTRACARDIAC STRUCTURES 

The problem of direct surgical attack upon intra-cardiac structures has vexed 
investigators since the idea was first entertained by Sir Lauda Brunton in 1902. * 
Techniques for the division of stenosed mitral and aortic valves have varied from the 
early blind use of hooks and knives 2 " 5 to the more recent well controlled methods of 
division of the mitral valve worked out by Bailey 9 , Harken 10 , and Smithy 6-8 . 

It is the purpose of this paper to present an approach for producing experimental 
mitral insufficiency. This idea evolved from a desire to produce insufficiency in dogs 
with the least possible insult to cardiac physiology resulting from the method itself. 
This has been accomplished in each case without changing the normal position of the 
heart, with only slight trauma to the heart wall, and with minimal hemorrhage. 

Materials consist of a triple zero braided steel suture on a 7 cm. pliant dull atrau- 
matic needle. 

The left hemithorax is opened between the fourth and fifth ribs. The lung is pro- 
tected with moist gauze. A longitudinal incision is made in the pericardium, anterior 
and parallel to the phrenic nerve. The position of the heart is maintained by grasping 
a pericardial reflexion near the left auricle with a straight clamp. The especially pre- 
pared needle is bent to a full curve and is introduced into the cavity of the left auricle 
lateral to the base of the appendage. The needle is passed through the center of the 
auriculo-ventricular orifice and is directed out through the lateral wall of the left 
ventricle 2 cm. inferior to the auriculo-ventricular groove. One now has a suture pass- 
ing into the left auricle between the mitral cusps and out through the wall of the 
ventricle. The needle is now straightened to a one half curve and is reintroduced into 
the left ventricle at its exact point of exit, a maneuver which is greatly facilitated by 
the dull point. By placing a finger on the wall of the ventricle superior to the puncture 
site, one is then able to direct the dull point of the needle along the inner wall of the 
heart through the base of the valve cusp along the wall of the auricle and out the 
original point of the entrance. The two ends of the suture are now grasped, and that 
distal suture remaining outside is pulled into the left ventricle, thus forming a loop 
about the valve cusp. (Figure 1) 

One can then divide the cusp by slight traction combined with a to and fro motion 
of the suture which, because of its strength and hard scabrous surface, may be used 
in somewhat the same manner as one would use a Gigli saw. When the cusp is com- 
pletely divided, the suture becomes slack and can be pulled out through the original 
point of entrance. 

* From the Department of Surgery, School of Medicine, University of Maryland, Baltimore, 
Maryland. 

t Received for publication April 10, 1951. 

57 



58 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



The wound, resulting from the repeated penetration of the ventricle, has in no 
case required a hemostatic suture. Hemorrhage from the auricle has been easily con- 
trolled by a single bite with a straight clamp applied after final withdrawal of the 
suture. This not has been necessary in every case. 

Topical and intramural procaine was used in one-half of the cases with no apparent 
difference in results. 

Insufficiency has been indicated at the time of operation by an immediate enlarge- 
ment of the left auricle accompanied by increased intra-auricular pressures. 




Fig. 1 



Post mortem examinations of ten dogs confirmed the division of the mitral valve 
in every case. Two months following operation, all cusps were found to be cleanly 
divided without evidence of healing. The absence of torn or ragged edges is probably 
caused by the suture material being used as a saw, while the pull of the chordae ten- 
dinae prevents folding or wrinkling of the cusp. 

This method of valvulotomy has proved to have several distinct advantages when 
used on the experimental animal. Operating time is shortened. The heart remains 
in its normal position. There is practically no hemorrhage, and trauma to the heart 
wall is minimal. Although the procedure is completely blind, one has excellent con- 
trol of the position of the cutting suture as evidenced by the post mortem examination 
of the ten dogs in this series. 



PEXTOX AND BRANTIGAN— INTRACARDIAC STRUCTURES 59 

Experimentally, the method has also been used to divide the interauricular sep- 
tum, the tricuspid, pulmonary, and aortic valves. 

In the only patient in which this technique has been used, an eleven month old 
infant, no difficulty was encountered in producing an interauricular septal defect 
1 cm. in length. Neither was serious hemorrhage encountered. However, the patient 
was an extremely poor risk and died immediately following the closure of the chest. 
A post mortem examination of the heart revealed dextro-position of the aorta, an 
interventricular septal defect, and a patent ductus arteriosis. 

REFERENCES 

1. Brunton, L.: Preliminary Note on the Possibility of Treating Mitral Stenosis by Surgical 

Methods. Lancet, London, 1: 352 (1902). 

2. MacCallum, W. C: On the Mechanical Effects of Experimental Mitral Stenosis and Insuffi- 

ciency. Bull. J. H. H., 185: 260 (1906). 

3. Cushing, H. and Brance, J. R. B.: Experimental and Clinical Notes on Chronic Valvular 

Lesions in the Dog and Their Possible Relation to a Future Surgery of the Cardiac Valves. 
Med. Res., 17: 471 (1907). 

4. Cutler, E. C, Levine, S. A., and Beck, C S-: The Surgical Treatment of Mitral Stenosis: 

Experimental and Clinical Studies. Arch. Surg., 9: 689 (1924). 

5. Cutler, E. C. and Beck, C. S.: The Present Status of Surgical Procedures in Chronic Val- 

vular Disease of the Heart. Arch. Surg., 18: 403 (1929). 

6. Smithy, H.: Experimental Aortic Valvulotomy. Surg., Gynec., and Obst, 84: 625 (1947). 

7. Smithy, H.: Aortic Valvulotomy. Surg., Gynec, and Obst., 86: 513 (1948). 

8. Smithy, H.: Surgical Treatment of Constrictive Valvular Disease. Surg., Gynec, and Obst., 90: 

175 (1950). 

9. Bailey, C. P., et al.: The Surgery of Mitral Stenosis. J. Thoracic Surgery, 19: 16 (1950). 
10. Harken, D.: The Surgical Treatment of Mitral Stenosis. J. Thoracic Surgery, 19: 1 (1950). 



FASCIAE AND SUBPERITONEAL FASCIAL SPACES OF THE MALE 

PELVIC CAVITY* 

EDUARD UHLENHUTH, PH.D.**fH 

The peritoneal sac, although it extends from the abdomen into the pelvis, does 
not descend all the way to the pelvic diaphragm. Its most caudal level is attained in 
the male rectovesical pouch about three inches (and in the female rectovaginal pouch 
of Douglas about two inches) cranial to the anterior commissure of the anus. Be- 
cause of this arrangement, the entire supradiaphragmatic part of the pelvic cavity 
is divided by the peritoneum into a supraperitoneal portion and a subperitoneal 
space. The latter is located between the peritoneum and the pelvic diaphragm and 
is continuous with the retroperitoneum of the abdomen in which the kidneys and 
ureters are contained. 

The present article concerns only the subperitoneal space of the pelvic cavity, and 
structures which are located below the peritoneum. Although in the male only two 
major organs (bladder and rectum) are contained in this space, this part of the pelvic 
cavity is beset with difficult problems of spacial orientation as it is subdivided into a 
number of secondary "fascial" compartments by partitions which represent parts of 
the "visceral endopelvic fascia". Visualization, study, and presentation of the rela- 
tionships between the different fascial spaces and of the many different levels and 
planes of the individual fascial sheets is one of the major tasks for the anatomist, 
teacher and surgeon. 

A series of special dissections of the cadaver, suitable to the study and demonstra- 
tion of the visceral fasciae and fascial spaces of the pelvis have been prepared. Struc- 
tures occupying a relatively small space in many different planes, present a difficult 
problem to the artist who attempts to illustrate them. Two-dimensional illustrations 
give only a partial visualization of complicated three-dimensional bodies; neverthe- 
less, an attempt will be made to discuss this subject with the aid of some specially 
selected pictures. 1 This is done to establish the importance of visceral endopelvic 
fasciae in the dissecting room and in surgery. 

Parietal Endopelvic Fascia 

The parietal endopelvic fascia is briefly mentioned here because through it, the 
visceral fasciae gain attachment to the walls of the pelvic cavity, and because of its 
important relationship to vessels and nerves. 

The parietal endopelvic fascia is the fascia which lines the pelvic cavity in one 
continuous sheet and covers the muscles of the pelvic wall and floor. This fascia pre- 
sents a peculiar relationship to vessels and nerves, which is useful to remember. Al- 

* Adapted for publication from a lecture introductory to a demonstration course given as part 
of a "Postgraduate Urological Seminar," at the Baltimore meeting of the "Mid-Atlantic Section 
of the American Urological Association," January 30 and 31, 1950. 

** Aided by a grant from the John F. B. Weaver Fund of the School of Medicine, University of 
Maryland, and a personal contribution from Dr. Albert E. Goldstein. 

f From the Department of Anatomy, University of Maryland School of Medicine. 

H Received for publication July 1, 1950. 

60 



UHLENHUTH— FASCIAE OF MALE PELVIC CAVITY 61 

though there exist several accounts in which such a relationship is denied or mini- 
mized (3), it can nevertheless be demonstrated by dissection that the parietal fascial 
forms a partition between the neural and vascular levels. With the exception of a 
single nerve in the cavity of the lesser pelvis (obturator nerve), not one of the somatic 
nerves can be seen within the space lined by the parietal fascia. All the somatic 
nerve-trunks and the lumbosacral, pudendal and coccygeal nerve plexuses are 
located "subfascial"; that is to say, between the parietal fascia and the muscles 
covered by it. In order to display them, the parietal fascia must be incised and 
stripped away from the muscles. 

Quite the contrary is true for the vessels and for the autonomic nerve plexus. The 
vessels are located inside the space lined by the parietal fascia and are embedded in 
the visceral fascia. The parasympathetic nerves originate from the sacral trunks in 
the subfascial space but pierce immediately the parietal fascia, enter the pelvic 
cavity, and travel in special visceral fascial sheaths to the viscera which they supply. 
To find them, the parietal fascia need not be disturbed ; rather it is necessary to know 
the visceral sheaths in which they travel. 

Neurovascular Sheaths, A Reality 

While the configuration of the parietal endopelvic fascia is relatively simple, the 
visceral endopelvic fascia is difficult to demonstrate and to describe. Anatomists 
attempted to escape presentation and analysis of this part of pelvic anatomy by re- 
ducing the entire visceral endopelvic fascia to the fascial capsules, ensheathing such 
organs as the bladder, prostate gland, vagina, and rectum. This also includes simple, 
diffusely distributed, undifferentiated, loose packing tissue (8). General agreement 
exists concerning the fascial capsules: also the presence of loose packing tissue is 
generally granted. The most controversial subject, however, is the neurovascular 
sheaths, the presence of which is not generally recognized. They do exist and can 
be distinctly demonstrated if proper dissection is made. These sheaths serve as 
conduits for vessels and nerves which they carry from the periphery of the pelvic 
cavity to the organs, and are an important component of the fixation apparatus by 
which the pelvic viscera are anchored to the pelvic walls and floor. Each of these 
sheaths is composed of two fascial membranes between which loose packing tissue, 
fat, nerves, blood, and lymph vessels are embedded. 

From the surgical viewpoint the great importance of the neurovascular sheaths 
has been particularly emphasized by gynecologists. Foremost among them were 
Wertheim and Schauta. Their pupils, Peham and Amreich, in their classical work 
on "Operative Gynecology", gave the first exhaustive description of these structures. 

Line of Anchorage 

The neurovascular sheaths or the hypogastric wings are "anchored" peripherally 
to the parietal fascia and are attached centrally to the fascial capsules of the viscera, 
with which they are continuous. 

The "line of anchorage" has been well illustrated by Eduard Pernkopf in his 
monumental work "Topographische Anatomie". It starts (Fig. 1) cranially at the 
point where the hypogastric artery originates from the common iliac artery and passes 



62 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



downward and backward (roughly in a vertical direction), along the hypogastric 
artery and its anterior division, to the ischial spine, approximately parallel to the 
dorsal margin of the superior ischial ramus and in front of the greater sciatic fora- 




L 



Fig. 1 



The anchorage line of the visceral endopelvic fascia as illustrated by Pernkopf under the name 
of "neurovascular plate" (Gefaess-Nerven-Leitplatte). Both the vertical (1) and the horizontal 
portion (2) as well as the angle which they form against one another are shown. Cranial to the hori- 
zontal part of the anchorage line, the tendinous arch of Levator ani (3) is seen. The parietal fascia 
has been left in place; through it the muscles and the trunks of the sacral plexus are showing. Note 
the two fascial leaves bordering the vertical portion of the anchorage line. 

Taken from Pernkopf's Topographische Anatomie, 1943, vol. II, Fig. 71 (redrawn and somewhat 
modified) . 

men. At the level of the ischial spine, it makes a sharp turn forward of nearly 
90 degrees, passing forward and downward (roughly in a horizontal plane) across 
the levator ani, ending close to the lower end of the symphysis pubis. 

The vertical portion of the line of anchorage is the "hypogastric root", the hori- 



UHLENHUTH— FASCIAE OF MALE PELVIC CAVITY 63 

zontal portion being represented by the well known "fascia endopelvina", a some- 
what confusing term the use of which has continued only because of its antiquity. 

The hypogastric root is a thick strip of visceral fascia which is bordered on either 
side, laterally and medially, by distinctly membranous layers of fascia arising from 
the parietal fascia (Fig. 1). Between these two layers are contained the ventral divi- 
sions of the hypogastric vessels, the origins of the visceral branches of these vessels, 
and the ureter. 

The fascia endopelvina is a horizontal fascial shelf which forms the floor of the 
space of Retzius and is encountered if the hand is pushed down into this space. It 
will be discussed later in the section describing the space of Retzius. It arises from 
the parietal fascia along the so-called "white line" of the fascia endopelvina. This 
structure commences dorsally at the spine of the ischium, crosses the levator ani, 
and runs forward to the lower end of the symphysis pubis, where it meets with its 
fellow of the opposite side. If the space of Retzius is exposed to view by pulling the 
bladder away from the symphysis pubis and lateral pelvic wall (Fig. 2), the fascia 
endopelvina is seen as it occupies the floor level of the space of Retzius. 

General Appearance of Neurovascular Sheaths 

If the peritoneum is carefully raised, it is found that underneath it a continuous 
and well denned fascial membrane is present, expanded between the peritoneum 
and the parietal fascia. Figure 3 shows a preparation in which the entire peritoneum 
has been stripped away, leaving only the peritoneum of the bottom of the rectovesi- 
cal pouch. In such a preparation, the visceral fascia is seen to reproduce faithfully the 
general configuration of the peritoneum. If the fascia is now cautiously lifted off the 
pelvic walls, its sheet-like nature can be demonstrated. Such a dissection is illustrated 
in Figure 4. After the fascial sheet had been separated from the parietal fascia, it 
was elevated by hooks and held stretched out in a wire frame to demonstrate the na- 
ture of this fascia as a well differentiated individual structure. Any one of these fascial 
sheets may be grasped and pulled with force to demonstrate the great resistance of 
the visceral sheets to tension. 

As is shown in Figure 4, the visceral endopelvic fascia is continuous everywhere, 
with a similar fascia in the abdomen (visceral endogastric fascia). Ventrally, it is 
continued into the vesicoumbilical fascia; laterally, into the visceral endogastric 
fascia of the iliac fossa; and dorsally, it becomes continuous with a fascia which en- 
closes, among many other structures, the ureter and the large vascular trunks of the 
abdomen and, further cranially, represents the perirenal fascia. 

In Figure 3, the major neurovascular sheaths, of which the visceral endopelvic 
fascia is composed, are visible partly or in their entirety. The location of the hypo- 
gastric root (vertical anchorage line) is indicated by the cranial (vertical) portion of 
the ureter. Arising from it are two extensive fascial sheaths, dorsal and ventral. The 
dorsal or presacral hypogastric wing sweeps across the sacrum and becomes continu- 
ous with its fellow of the opposite side. The ventral wing sweeps forward along the 
lateral wall of the pelvis and is divided by the horizontal (ventrocaudal) portion of 
the ureter and by the bladder into a superior and inferior hypogastric wing. The 
presacral wing is that part of the fascia which is continued into the fascia around the 



64 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



aorta, inferior vena cava, and perirenal fascia. The superior hypogastric wing is 
continued laterally into the visceral fascia of the iliac fossa, extends downward and 
forward from the external iliac vessels to the bladder and is continuous with the 
capsule on the superior surface of the bladder. It contains the horizontal portion of 
the vas deferens and also the umbilical arteries, following them upon the ventral wall 




Fig. 2 
Floor of the space of Retzius 

Peritoneum stripped away and removed. Right superior hypogastric wing and vesico-umbilical 
fascia cut away from their peripheral attachments and pulled laterally and dorsally together with 
the bladder, to obtain a view into the ventral and right lateral compartments of the space of Retzius. 

1) Superior hypogastric wing with umbilical artery. 2) Vesico-umbilical fascia. 3) Bladder (in- 
ferolateral surface). 4) Deep dorsal vein of penis. 5) Medial pubovesical ligament. 6) Lateral pubo- 
vesical ligament. 7) Lateral true ligament of bladder (ventral portion of fascia endopelvina). 8) 
Dorsal crescentic margin of lateral true ligament of bladder. 9, 10 and 11) White lines of origin of 
fascia endopelvina. 12) Cranial commencement of hypogastric root, with ureter in it. 13) Presacral 
hypogastric wing. 14) Fascial core of mesosigmoid. 

Pelvis (479. „ . , 1948, fig. 7) of white male, 70 vears of age. 
42 b 

of the abdomen where it forms, between the left and right obliterated umbilical arter- 
ies, the vesicoumbilical fascia. The inferior hypogastric wing which is only partially 
visible, lies caudal to the horizontal part of the ureter. It runs forward and downard 
toward the posterior surface of the bladder and prostate gland and is attached to the 
capsules of these organs. 



UHLENHUTH— FASCIAE OF MALE PELVIC CAVITY 



65 



Both the dorsal and the ventral wing are attached in their entirety to the anchorage 
line. In Figures 3 and 4, only the vertical portion (hypogastric root) of this line is 
visible. 



V l-3 




Fig. 3 
Visceral endopelvic fascia, after removal of peritoneum 

Peritoneum pealed away from visceral endopelvic fascia and cut away except at the bottom of 
rectovesical pouch. 

1) Rectovesical pouch. 2) Cranial continuation of rectovesical septum. 3) Transversalis (parietal) 
fascia. 4) Psoic (parietal) fascia. 5) Iliac (parietal) fascia. 6) Hypogastric root, with ureter in it. 
7) Presacral wing, with fascial core of mesosigmoid. 8) Superior hypogastric wing, with horizontal 
portion of vas deferens (9) and obliterated umbilical artery (10) in it. 11) Vesico-umbilical fascia. 
12) Visceral endogastric fascia on ventral abdominal wall. 13) Visceral endogastric fascia in iliac 
fossa. 

Pelvis (479 , fig. 3) of male negro, 68 years of age. 

Superior Hypogastric Wing 

As mentioned above, the ventral wing is divided into a superior and an inferior 
portion. Dorsally, this division is effected by the ureter, without breaking the con- 
tinuity between the two portions. Ventrally, the continuity between the superior 
and inferior hypogastric wings is actually interrupted as the bladder is interposed 
between them. 

In Figures 3 and 4, the superior hypogastric wing is seen from its medial aspect. 
In Figure 5, the superior hypogastric wing was cut away from its attachment to the 



66 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF AID. 



external iliac vessels and, together with the bladder, was turned medially. It is now 
visible from its lateral aspect which faces the space of Retzius. By pulling the bladder 
medially, the space of Retzius has been opened in its entire extent. Dorsally, the 
hypogastric root is visible. The superior hypogastric wing is seen as it arises from the 




«"-* 



L 



Fig. 4 



Neurovascular wings of visceral endopelvic fascia 

Peritoneum pealed off and cut away except for the peritoneum of the bottom of rectovesical 
pouch. Visceral endopelvic fascia and its continuations into the visceral endogastric fascia lifted 
off the parietal fascia and held spread out and suspended by hooks. 

1) Rectovesical pouch. 2) Hypogastric root with ureter. 3) Presacral wing with fascial core of 
mesosigmoid and 4) its continuation into the fascia of abdominal retroperitoneum. 5) Superior 
hypogastric wing with 6) Horizontal portion of vas deferens. 7) Lateral continuation of superior 
wing into iliac fossa. 8) Ventral continuation of superior wing upon ventral abdominal wall and 
9) into vesico-umbilical fascia. 10) Rubber tube in retrorectal space. 11) Rubber tube in lateral 
compartment of space of Retzius. 

Pelvis (479 , 1949, fig. 2) of a white male, aged 72 years. Dissection made by DeWitt T. Hunter. 

hypogastric root, passes forward and, reaching the lateral angle of the bladder, at- 
taches itself to the lateral margin of the superior bladder surface. The umbilical artery 
runs in it, close to the margin along which the wing was cut away from its lateral 
attachment. The umbilical artery gives rise to the superior vesical arteries (not shown 
in Figure 5). There may be as many as five such branches, all of which are enclosed 



UHLENHUTH— FASCIAE OF MALE PELVIC CAVITY 



67 



between the two fascial layers of this wing and are carried by it to the superior, and 
part of the posterior, surface of the bladder. 

In the male, the vas deferens runs on the superior surface of this wing, pursuing a 
horizontal course toward the spine of the ischium, where it pierces the fascia, takes a 



r 




%zrfT, 




Fig. 5 
Neurovascular wings of visceral endopelvic fascia 

Peritoneum pealed away and removed. Superior hypogastric wing cut away from its lateral 
attachment and, together with the bladder, pulled medially. View into space of Retzius. 

1) Superior hypogastric wing, seen from its lateral aspect. 2) Bladder (inferolateral surface). 
3) Hypogastric root. 4) Inferior hypogastric wing, with inferior vesical vessels in it. 5) Presacral 
hypogastric wing. 6) Medial pubovesical and 7) Lateral pubovesical ligament, both freed of their 
fascial covering. 8) Lateral true ligament of bladder, with covering of thin fascia endopelvina left 
in place. 9) Peritoneum in iliac fossa. 10) Visceral endogastric fascia in iliac fossa, continued from 
superior wing. 

Right half of pelvis (479 , 1946, fig. 5) of colored female, 29 years of age. 



sharp turn caudally, and enters the retrovesical space as shown in Figure 8. The 
superior wing excludes the vas deferens from the space of Retzius which lies caudal 
to this wing (see below). It should be kept in mind that the vas deferens is nowhere 
in actual contact with the floor of the pelvis. In its horizontal course, while running 



68 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

dorsally upon the superior wing, the vas crosses medial and cranial to the obliterated 
umbilical artery. 

Inferior Hypogastric Wing 

In Figure 5 the inferior hypogastric wing is shown in its entirety from its lateral 
aspect, facing the space of Retzius. Its relation to the superior wing and to the 
bladder is as follows: From its origin (hypogastric root), it passes forward in con- 
tinuity with the superior wing, delineated from it only by the ureter. As the lateral 
angle of the bladder is reached, the two wings become actually separated. The superior 
wing follows the lateral margin of the superior bladder surface, while the inferior wing 
becomes attached to the lateral margin of the posterior bladder surface. In Figure 5 
the origin of the inferior wing from the hypogastric root as well as from the fascia 
endopelvina (horizontal part of anchorage line) is visible. The inferior vesical veins 
and arteries are contained in this wing and are carried in it down to the dorsal and 
inferior bladder surfaces to the seminal vesicles, ampullae of vasa deferentia and 
prostate gland. Some of them are illustrated in Figure 5. 

The inferior wing has a special relation to the hypogastric root shown in Figure 
6 which is another stage of the dissection of the female pelvis illustrated in Figure 5. 
The pelvis here was tilted so as to expose a view of the entire anchorage line. Its 
vertical portion, the hypogastric root, ends caudally in a toughened arch, the inferior 
vesical arch, which can be distinctly felt with a finger pushed dorsally in the 
space of Retzius. Laterally, this arch is attached to the ischial spine; medially, it is 
continued into the inferior wing. In it are situated large inferior vesical veins and 
one or several inferior vesical arteries. In the dissection shown in Figure 6, a win- 
dow was cut out of the fascia covering the ventral surface of the inferior vesical 
arch; through it the inferior vesical vein is seen passing to the hypogastric veins. 
Just below the inferior vesical arch, one finds frequently a second arch (Fig. 6) 
which marks the dorsal end of the fascia endopelvina. The convexities of the two 
arches facing each other and the space between them is filled in by fat and a fascial 
membrane of varying strength. This second arch marks the location of the tough, 
strongly aponeurotic, superior margin of the coccygeus muscle. In many cases the 
terminal branches of the anterior division of the hypogastric vessels, the inferior 
gluteal and internal pudendal, pass into the infrapiriform space of the greater sciatic 
foramen just behind this second arch, while the inferior vesical vessels are joined to 
the anterior division of the hypogastric artery a short distance cranial to this arch. 
This kind of arrangement, together with the attachment of the inferior vesical arch 
to the ischial spine, furnishes a particularly strong and effective mooring of the 
inferior hypogastric wing to the wall of the pelvis, very resistant to tension exerted 
in a ventral direction. 

The inferior hypogastric wing is of considerably greater bulk than the other wings. 
This is shown in a special dissection (Fig. 7), illustrating the inferior wing and the 
bladder from a medial and dorsal aspect. After stripping away the peritoneum, the 
superior wing was cut away from the inferior wing and from the bladder. The 
medial fascial layer of the inferior wing; as well as the capsule on the dorsal 
bladder surface, (the two being continuous with one another) were dissected away 



VHLENHUTH— FASCIAE OF MALE PELVIC CAVITY 



69 




Fig. 6 
Hypogastric root, inferior vesical arch and fascia endopelvina 

Same dissection as Fig. 5, but promontory of pelvis tilted forward to afford full view into lateral 
compartment of space of Retzius. Fascia endopelvina more fully dissected. 

1) Hypogastric root. 2) Inferior vesical arch with window through which an inferior vesical 
vein is shown. 3) Medial pubovesical ligament. 4) Lateral pubovesical ligament. 5) Lateral true liga- 
ment of bladder; fascia endopelvina which covers it, incised and retracted, aponeurotic fibers of 
ligament displayed and incised, levator ani showing through incision. 6) Thin dorsal portion of 
fascia endopelvina, incised, portio cardinalis of levator ani and, further dorsally, coccygeus muscle 
showing through incision. 7) Arch at dorsal end of fascia endopelvina. 8) Rubber tube stuck through 
fascia which closes opening between inferior vesical arch and dorsal arch of fascia endopelvina. 
9) Rubber tube stuck through incision in thin (avascular) part of fascia endopelvina. 

Right half of same pelvis as shown in Fig. 5 (479 .„ , 1946, fig. 7). 



and reflected. The core of the inferior wing is fully exposed. In the subject illustrated 
by Figure 7 it is fully one-half inch thick and gains in height as it passes from its 
dorsal origin to the bladder. It is one and one-half inches high where it is attached 



70 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



into the bladder. The core of the wing consists of loose packing tissue and consider- 
able amounts of fat. Embedded in it (not shown in the illustration) are the ureter, 
the autonomous nerves to the urogenital organs, and the arteries and veins supplying 







L 



Fig. 7 
Inferior hypogastric wing 



Peritoneum (except bottom of rectovesical pouch) removed, superior hypogastric wing cut away 
from inferior hypogastric wing and bladder, fascial leaves bordering inferior hypogastric wing, and 
their continuations upon the bladder dissected off to show core of inferior hypogastric wing. 

1) Core of inferior hypogastric wing, viewed from medial and dorsal. 2) Dorsal bladder surface. 
3) Medial fascial leaf of inferior hypogastric wing, and dorsal bladder capsule. 4) Lateral fascial 
leaf of inferior hypogastric wing, and superior bladder capsule. 5) Superior hypogastric wing cut 
away from inferior wing and from bladder. 6) Ureter (vertical portion) shelled out from hypo- 
gastric root. 7) Visceral nerves to urogenital organs, entering inferior wing from presacral wing. 
8) Peritoneum of rectovesical pouch. 9) Rectovesical septum. 10) Genital fascia with ampulla of 
vas deferens. 11) Middle lobe of prostate. 12) Dorsal lobe of prostate covered by fascial capsule. 

Right half of pelvis (479 , 1950, fig. 3) of white male, 54 years of age. 

and draining these organs. Ventrally, the inferior wing, is firmly attached to the 
lateral margin of the dorsal bladder surface and is continued there into the capsule 
on the dorsal (see Fig. 7) and inferolateral (see Fig. 5) surfaces of the bladder. Dor- 



UHLENHUTH— FASCIAE OF MALE PELVIC CAVITY 71 

sally, where the inferior wing arises from the hypogastric root, the ureter makes a 
sharp turn forward and enters the inferior wing, representing the most cranial struc- 
ture in its content and being carried in it to the lateral bladder angle. Also, two 
strong autonomous nerve trunks are seen in Figure 7, as they enter the inferior 
wing. 

In a preparation such as is illustrated in Figure 7, the inferior wing may be grasped, 
and tension in a ventral direction may be exerted upon it. This procedure demon- 
strates very convincingly that even vigorous pulling is unable to disengage the 
inferior wing from its mooring to the hypogastric root and inferior vesical arch. 

Through the intermediation of the inferior wing, the bladder is firmly moored to 
the hypogastric wing and inferior vesical arch. 

The Presacral Wing 

Both the inferior and superior parts of the ventral wing are related to the bladder. 
The dorsal or presacral wing is related to the pelvic colon and to the rectum. Like 
the ventral wing, it takes its origin along the entire line of anchorage; that is, in its 
cranial extent from the hypogastric root, and in its caudal extent from the fascia 
endopelvina. In its course from cranial to caudal, it mades the same angle at the 
level of the ischial spine. This is described by the line of anchorage and therefore 
follows the direction of the rectum which in the lower part of its sacral curvature 
also undergoes a change from a vertical to a horizontal direction, passing from the 
coccyx forward to the prostate gland. 

The cranial portion of the presacral wing, as shown in Figures 3, 4 and 5, is wide 
and sweeps across the sacrum where it meets with its fellow of the opposite side. 
It is applied by its dorsal surface to the parietal fascia over the piriformis muscle 
and sacrum. In its caudal portion it narrows down and is applied to the parietal 
fascia over the coccygeus and levator ani muscles. 

Cranially, the presacral wing passes behind the pelvic colon, but is attached to 
the dorsal aspect of this part of the gut by way of the mesentery of the pelvic colon, 
the core of which is formed by a ventral expansion of the presacral wings (Figs. 
2, 3 4). Further caudally, where a mesentery is absent, each of the two presacral 
wings is attached into the corresponding lateral aspect of the rectum and is continu- 
ous with the fascial capsule of the rectum. Thus, it represents a lateral fascial wing 
of the rectum by way of which the rectum is fastened on either side to the medial 
margin of the fascia endopelvina and through it, to the parietal fascia of the levator 
ani. 

In its cranial part, the presacral wing contains, between its two fascial layers, 
some of the most caudal sigmoid branches of the inferior mesenteric artery, the 
superior hemorrhoidal artery, the inferior hypogastric nerve which descends down 
into the pelvis medial to the ureter, and the cranial half of the pelvic ganglion (see 
Retrorectal Space). In the caudal (horizontal) portion of the presacral wing, the 
caudal half of the pelvic ganglion is embedded. 

Subperitoneal Fascial Spaces 

The hypogastric wings, aided by an additional membranous structure, the recto- 
vesical septum (to be described presently), divide the entire subperitoneal space of 



72 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

the male pelvis into four fascial spaces. These are (from ventral to dorsal): the 
space of Retzius, the retrovesical space, the prerectal space, and the retrorectal 
space. The fascial partitions between these spaces and the spaces themselves are 
arranged in such a fashion that all of them commence, dorsolaterally, at a common 
center represented by the hypogastric root and the spine of the ischium with the 
inferior vesical arch attached to it; from this center they radiate, fan-like, towards 
the midsagittal plane of the pelvic cavity. This arrangement enables the arteries 
and nerves, arising in or carried into the hypogastric root from elsewhere, to enter 
any one of the fascial partitions and to reach the organs which they supply. In the 
same manner, the veins and lymphatics draining the viscera are carried to the com- 
mon center in the hypogastric root and from there up into the abdomen. 

Retrovesical Space 

As the seminal vesicles and the ampullae of the vasa deferentia are situated in this 
space, and because through it, access to the dorsal surface of the prostate gland can 
be gained, it is a region of major importance for the urologist. It represents the 
ventral compartment of the space between the bladder and the rectum (rectovesical 
space) and is partitioned off against the dorsal compartment (prerecetal space) 
of this larger space by a well defined membrane, the so-called rectovesical septum. 

1. Rectovesical Septum: The rectovesical septum is a membrane which is attached 
firmly by its cranial margin to the peritoneum of the rectovesical pouch (Fig. 8). 
Laterally, it extends further cranially, sometimes as high as the cranial end of the 
hypogastric root, forming on either side of the pelvic cavity a lateral wing of the 
peritoneal sac (Fig. 3). In some subjects the rectovesical spetum extends caudally 
all the way down to the pelvic floor (Fig. 9). Laterally, it is attached to the common 
anchorage line (to the hypogastric root and medial margin of the fascia endopelvina) ; 
cranially, however, its line of lateral attachment is variable inasmuch as it may be 
attached medial to the hypogastric root and then gain insertion into the lateral 
portion of the presacral wing. In either case, this septum extends transversely through 
the entire width of the pelvic cavity. It thus forms, either by itself or together with 
a most lateral strip of the presacral wing, a partition of the subperitoneal space of 
the pelvic cavity into a dorsal or rectal and a ventral or urogenital compartment. 
In cases in which the rectovesical septum is well developed, it may well represent at 
least for a time an efficient barrier to the passage of abscesses and exudations from 
one compartment into the other. 

The rectovesical septum is the result of a fusion between the ventral and dorsal 
walls of the peritoneal rectovesical pouch, which in early embryonic life extends 
between bladder and rectum all the way down to the pelvic floor (Uhlenhuth, Wolfe, 
Smith and Middleton (7)). Therefore, this septum consists, potentially, of two layers, 
an anterior and a posterior layer. With proper care it actually may be split into these 
two layers. In adult subjects in whom this septum is well developed, it can be im- 
mediately distinguished from ordinary fascia by a conspicuous difference in texture 
and consistency. It is a dense, smooth sheet, often of shiny appearance. 

Denonvilliers was the first one to describe the rectovesical septum, (1836), naming 
it "Aponevrose prostato-peritoneal". Yet it has not been determined with any 



UHLEXHUTH— FASCIAE OF MALE PELVIC CAVITY 



73 



degree of certainty that what present-day urologists call the "posterior layer of 
Denonvilliers' fascia" is the rectovesical septum. In his "Practice of Urology" 
(vol. II, p. 420), Young states that .the posterior layer of Denonvilliers' fascia is 
identical with the rectovesical septum, while the anterior layer of this fascia is 
represented by the capsule on the dorsal surface of the prostate gland. But the ana- 




Fig. 8 
Retrovesical space 

Peritoneum removed, except for bottom of rectovesical pouch. 

1) Peritoneum of rectovesical pouch. 2) Rectovesical septum. 3) Supragenital septum. 4) Cap- 
sule on dorsal bladder surface. 5) Capsule on ventral surface of rectum. 6) Superior hypogastric wing. 
7) Vas deferens (horizontal part). 8) Vas deferens (ampulla), vertical part, in retrovesical space. 
9) Presacral wing. 10) Ureter and 11) Hypogastric artery, both abnormally far ventral (caudal pole 
of kidney in iliac fossa). 

Right half of pelvis (479 ., 1947, fig. 2) of white male, 77 years of age. Dissection made by 
43 l 

Dr. Karl F. Mech. 



tomic description of the posterior layer which he gives in his account of the tech- 
nique of perineal prostatectomy, contains so many inconsistencies and is so vague, 
that one cannot be certain that the structure which he describes is actually the 
rectovesical septum. In an article published in 1908, G. Elliot Smith gave a dia- 
grammatic illustration (Fig. 10 on p. 212). From this it appears that when he de- 



74 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



scribed a posterior and anterior layer of Denonvilliers' fascia, he had in mind the 
two primary leaves of which compose the rectovesical septum. Since both of these 
primary layers are attached cranially to the peritoneum of the rectovesical pouch, 
the retroprostatic space (of Proust) in this illustration extends all the way up to 







Fig. 9 
Rectovesical septum and genital fascia 

Peritoneum pealed away from visceral fascia and cut away except for peritoneum of rectovesical 
pouch. The retrovesical space (between bladder and rectovesical septum) opened up. 

1) Rectovesical pouch. 2) Rectovesical septum. 3) Line along which rectovesical septum is grown 
to cranial margin of dorsal lobe of prostate gland. 4) Cranial expansion of rectovesical septum. 
5) Fascial capsule of dorsal lobe of prostate. 6) Genital fascia, with ampulla of vas deferens enclosed 
between its two layers. 7) Sacrogenital ligament (exceptionally well developed). 8) Superior wing 
with horizontal part of vas deferens (9) and obliterated umbilical artery (10). 11) Ureter (vertical 
part) in hypogastric root. 12) Middle and 13) Dorsal lobe of prostate gland. 

Left half of pelvis (47951, 1950, fig. 5) of white male, 54 years old. 



the bottom of the rectovesical pouch and lies within the rectovesical septum and 
the capsule of the prostate gland. 

Added to these difficulties, the anatomist encounters, in an attempt to interpret 
the language of the urologist in anatomic terms, the disregard of variations of the 
rectovesical septum which in some cases results in complete absence of a posterior 
layer of Denonvilliers' fascia dorsal to the prostate gland. It is true, as mentioned 



UHLENHUTH— FASCIAE OF MALE PELVIC CAVITY 75 

above, that in some subjects the rectovesical septum is a strong and well-defined 
membrane. However, in other individuals, this structure is greatly deficient and 
consists only of isolated narrow strips of varying length extending, at the most, 
to the base of the prostate gland. In some subjects, the rectovesical septum stretches 
all the way down to the pelvic floor (as was the case in the subject illustrated in 
Fig. 9). In many cases, the rectovesical septum is attached to the margin of the 
base of the prostate or along some line farther caudal on the dorsal surface of the 
prostate. It cannot be dissected any further down because it fades out into the 
prostatic capsule. In all these instances, the prostate gland is separated from the 
ventral capsule of the rectum only by loose areolar tissue, filling in a rectoprostatic 
space. However, a retroprostatic space, in the sense of a space between the recto- 
vesical septum and the prostate, is not developed. 

Even in those cases in which the rectovesical septum extends down to the pelvic 
floor, it presents constantly a firm attachment to the cranial margin of the posterior 
lobe of the prostate gland (as mentioned also by Lowsley and Kirwin, vol. I, p. 796), 
whereas everywhere else in the dissection of the rectovesical septum, separation can 
be made easily with a blunt instrument. The sharp edge of the knife is necessary to 
detach the rectovesical septum in this place. Frequently, as the rectovesical septum 
is cut away from this attachment, the outer capsule of the prostate gland comes 
along with the septum (Fig. 9). This capsule, as seen in embalmed dissecting-room 
specimens, is about of the same thickness as the rectovesical septum and of apo- 
neurotic appearance. After peeling this capsule away from the prostate gland, a 
thicker marginal zone, lighter in color than the rest of the prostatic tissue, remains. 
This marginal tissue can be peeled away with the aid of the semiblunt edge of a 
spatula-probe. It is brittle and does not have the consistency or appearance of a 
true fascial capsule. The middle lobe has its own individual capsule which seems to 
be a continuation of the capsule on the dorsal bladder wall (Fig. 7). 

When, in the sagittally divided pelvis of embalmed cadavers, an attempt is made 
to pull the rectum away from the bladder and prostate gland, the rectovesical septum 
goes invariably with the latter two organs and not with the rectum. It is only 
loosely attached to the rectum by a quantity of delicate areolar tissue which is 
easily broken down either with the finger or, in some subjects, by mere tension. 

2. Supragenital Septum: Gynecologists are well acquainted with the presence of 
a fascial septum, the supravaginal septum, which forms the roof of the vesicovaginal 
space, and which separates this space from the vesicocervical space. This must be 
cut through if access is to be gained from one into the other of these two spaces. A 
similar, though less substantial, septum forms the roof of the retrovesical space in 
the male (Fig. 8). 2 This "supragenital septum" must be cut through if access to 
the seminal vesicles, ampullae, and prostate gland from the intrapelvic side is sought. 
As is shown in Figure 8, the supragenital septum is attached dorsally to the perito- 
neum of the rectovesical pouch, ventrally to the bladder capsule along the dorsal 
margin of the superior bladder surface, and laterally to the ventral hypogastric wing 
along a line corresponding to the boundary between superior and inferior hypogastric 
wings. The vas deferens, which in its horizontal course runs towards the ischial spine 
in a special sheath on the upper surface of the superior wing, pierces this fascia just 



76 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



where it is joined to the supragenital septum and thus enters the retrovesical space 
(Fig. 8). Because of the presence of the supragenital septum, stripping away the 
peritoneum alone does not open up the retrovesical space (Fig. 10). To bring this 




Fig. 10 
Retrovesical space closed by supragenital septum 

Peritoneum pealed off and cut away except for the bottom of rectovesical pouch. Visceral endo- 
pelvic fascia left intact, retrovesical space closed by supragenital septum. 

1) Peritoneum of rectovesical pouch. 2) Cranial expansion of rectovesical septum. 3) Ureter in 
hypogastric root. 4) Presacral hypogastric wing. 5) Fascial core of mesosigmoid. 6) Superior hypo- 
gastric wing. 7) Bladder (superior surface). 8) Supragenital septum, closing retrovesical space. 

Pelvis (479 , , 1948, fig. 1) of white male, 70 years of age. Dissected by Dr. Edmund B. Mid- 

dleton. 



space into view, its fascial roof must be incised close to the dorsal margin of the 
superior bladder surface (Fig. 11). Digging downward and forward into this space 
with a finger, brings into view the vertical course of the vas deferens and the seminal 
vesicles as shown in Figure 11. Dorsal to the finger and in front of the rectum, a 



UHLENHUTH— FASCIAE OF MALE PELVIC CAVITY 



77 



strong membrane, the rectovesical septum, is visible. This can be picked up with a 
pair of forceps and lifted off the rectum. 

In the specimen illustrated in Figure 11, a knob-like projection with glistening 
whitish surface was seen protruding upward between the two ampullae. It was be- 




Fig. 11 

Retrovesical space opened up 

Same dissection as Fig. 10, but supragenital septum cut through transversely and retrovesical 
space opened. Ureter dissected out from inferior hypogastric wing as far ventrally as to the place 
where it is crossed by vas deferens. 

1) Supragenital septum incised transversely. 2) Retrovesical septum. 3) Vas deferens, hori- 
zontal portion, in superior hypogastric wing. 4) Vas deferens, vertical portion with ampulla, in retro- 
vesical space. 5) Seminal vesicle. 6) Bladder. 7) Prostate gland (presumably enlarged middle lobe). 
8) Ureter in hypogastric root. 9) Ureter in inferior hypogastric wing, crossed by vas deferens. 

Same pelvis as Fig. 10 (479 , 1948 fig. 2). Dissection made by Dr. Edmund B. Middleton. 

lieved to be en enlargement of the median lobe of the prostate, but was not further 
examined. Although the prostate gland can be felt, if the finger is thrust down far 
enough, the finger is unable to enter the retroprostatic space of Proust because of 
the firm attachment of the rectovesical septum to the cranial margin of the prostate 
gland (see Fig. 9). This attachment must be cut through before the dorsal surface of 
the prostate gland can be reached. 



78 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

In an attempt to enlarge the retrovesical space laterally, the fingers are stopped 
by a firm wall, the inferior hypogastric wing, which forms the lateral wall of this 
space. Following this wall, one can dig on either side of the rectum nearly as far 
back as the ischial spine and the hypogastric root. It is to be remembered that in the 
upper border of the inferior hypogastric wing, hidden under the fascial leaf which 
covers the medial surface of it, the ureter passes forward to the bladder and is 
crossed on its ventrocranial aspect by the vas deferens close to the point where the 
vas enters the retrovesical space and turns downward and forward (Fig. 11). More- 
over, coming out of the inferior hypogastric wing, piercing the fascial leaf which 
covers it, a number of nerves and arteries are seen, which supply the ampulla, seminal 
vesicles, prostate and dorsal bladder surface. These structures are seen to better 
advantage in Figure 12; the medial fascial leaf of the inferior wing has been lifted 
off the core of the wing, and the cranial end of the pelvic ganglion located. Large 
masses of nerves arise from it, some of them passing together with the ureter within 
the inferior wing forward to the bladder, while others pierce the medial fascial leaf 
and enter ampulla of vas and seminal vesicle. In Figure 12 also, the fascia covering 
the presacral wing was slit open just medial to the hypogastric root and ureter; 
the inferior hypogastric nerve is exposed and is seen to join the cranial end of the 
pelvic ganglion. 

3. The Genital Fascia : When the rectovesical septum is peeled away from the dor- 
sal bladder surface, the ampullae of the vasa deferentia and the seminal vesicles 
frequently remain attached to the ventral surface of the septum. Wtih proper care 
it can be shown that they are not directly attached to the rectovesical septum, but 
are enclosed in a separate fascia, the genital fascia, which is closely apposed to the 
septum and held loosely to it by a small amount of delicate loose connective tissue. 
It is actually fused only by its cranial margin either with the ventral surface of the 
septum or even with the supragenital septum (see Figs. 7 and 13). Around the seminal 
vesicles and the ampullae, the genital fascia is split into two layers, ventral and dorsal. 
These form a fascial sheath around these organs (Fig. 13). Caudally, the ventral 
layer is attached to the cranial margin of the middle lobe. The dorsal layer is attached 
to the cranial margin of the posterior lobe (Fig. 9). To free the vasa and seminal 
vesicles of this fascia consumes, at least in the cadaver, much time. But if the genital 
fascia is cut through along its cranial and caudal lines of attachment and the ejacula- 
tory duct is severed, these organs can be easily lifted out together with the genital 
fascia. 

Judging from the condition in the adult, one concludes that the genital fascia is 
homologous to the ligament of Mackenrodt in the female. In this connection, it is of 
interest that in the same way in which in the female the uterine nerves and vessels 
leave ureter and inferior vesical vessels (which pass within the inferior wing forward 
to the bladder) and turn medially towards the uterus, so the vessels and nerves for 
the seminal vesicles and ampullae in the male leave the inferior wing, turn medially 
and enter the genital fascia in the retrovesical space to supply these organs. 

4. Borders of Retrovesical Space: The retrovesical space is bordered vent rally by 
the dorsal surface of the bladder, dorsally by the rectovesical spetum, laterally 
(and ventrally) by the inferior hypogastric wings. It has a dorsolateral angle where 



UHLENHUTH— FASCIAE OF MALE PELVIC CAVITY 



79 



the inferior hypogastric wing and the rectovesical septum meet along the hypon- 
gastric root. It also has a caudolatera! angle, where the inferior hypogastric wing 




Fig. 12 

Nerve supply of seminal vesicles and vas deferens 

Same dissection as Figs. 10 and 11. Pelvic ganglion and its genito-urinary branches dissected out. 

1) Vas deferens; vertical portion cut through and pulled medially. 2) Seminal vesicle pulled 
medially. 3) Inferior hypogastric nerve in presacral wing. Lateral to it lies the hypogastric root 
with the ureter in it. 4) Ureter in the inferior hypogastric wing. 5) Medial fascial leaf of inferior 
wing lifted off the core of the wing and pelvic ganglion with its genito-urinary visceral branches 
dissected out. 

Same pelvis as Figs. 10 and 11 (479 , 1948, fig. 5). Dissection made by Dr. Edmund B. Mid- 

dleton. 



and the rectovesical septum meet along their common line of attachment to the 
fascia endopelvina. The roof of the retrovesical space is formed by the supragenital 



80 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



septum. It has no floor unless the cranial aspect of the posterior and middle lobes of 
the prostate gland is considered as such; see Figure 9. This is because an angle is 
formed where the rectovesical septum is attached to the prostate gland, between 
the septum and the bladder. Strictly speaking, the retrovesical space extends caudally 
only to this attachment between rectovesical septum and prostate. In cases in 




DlA^^_ 



Fig. 13 
Genital fascia 

Peritoneum raised and cut away except at the bottom of the rectovesical pouch. Vertical por- 
tion of ureter shelled out of fascia of hypogastric root, vas deferens cut where it crosses ureter. 
Supragenital septum incised transversely and walls of retrovesical space spread apart to show con- 
tents of space. Genital fascia separated from rectovesical septum; cranially it was attached in this 
subject to peritoneum of rectovesical pouch along same line as rectovesical septum. The rectovesical 
septum faded out into capsule on dorsal lobe of prostate gland. Ampulla of vas deferens shelled 
out from in between the two layers of genital fascia. 

1) Ureter in hypogastric root, accompanied by veins from vesical plexus. 2) Vas deferens in 
superior hypogastric wing, cut where it crosses ureter and pierces supragenital septum to enter 
retrovesical space. 3) Peritoneum of rectovesical pouch. 4) Rectovesical septum. 5) Capsule on dor- 
sal bladder surface, continued into medial fascial leaf of inferior hypogastric wing. 6) Supragenital 
septum. 7) Genital fascia. 8) Ampulla of vas. 9) Seminal vesicle. 10) Arteries entering retrovesical 
space from inferior wing. 

Left half of pelvis (479 , 1949, fig. 6) of colored male, 75 vears of age. 
45 



which the rectovesical septum extends caudally down to the pelvic floor, cutting 
through this attachment leads into the retroprostatic space of Proust. 

In Figure 2 the superior wing has been incised from dorsal to ventral. If the cut 
margins of this slit are pulled apart, one is enabled to look down into the lateral 
compartment of the space of Retzius. If a surgical needle is run through the lateral 
wall of the retrovesical space, it will be seen to appear in the space of Retzius. The 



UHLENHUTH— FASCIAE OF MALE PELVIC CAVITY 81 

retrovesical space is partitioned off against the lateral compartment of the space of 
Retzius by the inferior hypogastric wing. 

The Space of Retzius 

The space of Retzius is also known under the names of "retropubic" and "pre- 
vesical" space. In reality, this space is by no means confined to the retropubic region, 
but extends laterally on either side between the inferolateral surface of the bladder 
and the lateral wall of the pelvis, back to the spine of the ischium. It is composed of 
a ventral and two lateral compartments. The lateral compartments are continuous 
with one another through the ventral compartment. 

The space of Retzius has a floor and a roof, a dorsal, a medial, and a lateral wall. 
If the hand is pushed down between the bladder and the symphysis pubis, it is 
stopped at the level of the caudal end of the symphysis pubis by the floor of the 
space. If the hand is pushed backward between bladder and lateral pelvic wall, it is 
stopped by the dorsal wall. The latter constitutes a firm obstacle which prevents 
the hand from reaching the space behind the rectum. 

In some cases an attempt to pull the bladder away from the symphysis pubis is 
unsuccessful, owing to the presence of a sagittal septum which binds the keel of 
the bladder to the symphysis pubis. While this septum is a constant structure which 
divides the ventral compartment into a right and a left half, it is usually so thin that 
it can easily be broken down with the fingers. In other subjects, however, it is so 
stout, that it must be cut through with scissors before the bladder can be retracted. 3 

1. Dorsal Wall of Space of Retzius: The dorsal wall of the space of Retzius, 
shown in Figures 5 and 6, is represented by the vertical portion of the common 
anchorage line, the hypogastric root, and by the inferior vesical arch. Pushing one 
hand into the lateral compartment of the space of Retzius against the hypogastric 
root, and the other hand laterally as far as possible into the retrorectal space, will 
demonstrate convincingly that the hypogastric root prevents the two hands from 
touching each other. As it contains the ureter, one or several inferior vesical arteries 
and several large veins, it represents an impenetrable partition between the space of 
Retzius and the retrorectal space. 

2. Floor of the Space of Retzius : The floor of the space of Retzius is formed by 
the fascia endopelvina (Fig. 6). This fascia extends from the caudal end of the sym- 
physis pubis to the spine of the ischium where it becomes continuous with the fascia 
which covers the ventral surface of the hypogastric root. Its "appearance is, however, 
not the same throughout its extent. If the bladder is pulled away from the symphysis 
pubis and the lateral pelvic wall and a quantity of fat constantly present in the 
space of Retzius is carefully cleaned away, the most conspicuous structure seen in the 
floor of the space is a band (Figs. 2 and 5) of about 5 to 7 mm. width and of glistening 
appearance. The bladder is firmly attached to the pubic bone and to the fascia of the 
levator ani by this band. It is of varying length. In some subjects it can extend dorsally 
for a distance of 60 mm. Dorsally, it ends constantly in a sharp crescentic margin 
(Fig. 5). Dorsal to this margin, the fascia drops off to a lower level. It is of the usual 
dull appearance of fascia and of varying stoutness and is thin and transparent in 
many cases. In some subjects the whitish band may present, in addition so its most 
dorsal crescentic margin, one or several similar margins farther ventrally, or dorsally, 



82 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

to each of which the fascial band is continued at a lower level. In front, this band is 
bordered by a similar arch-like margin, but with its concavity pointing in the opposite 
direction. This ventral margin can be identified as a cord-shaped ligament, the pubo- 
vesical ligament. This is separated from the rest of the band by a slit-like interval. 
The band itself is known as the lateral true ligament of the bladder. Between the 
pubovesical ligaments of the two sides, a depression is located which is covered over 
with a thin fascia. Through this, the deep dorsal vein of the penis enters the pelvic 
cavity (Fig. 2). In some cases, two pubovesical ligaments, a medial and a lateral, 
are differentiated (Fig. 5). In the pelvis illustrated in Figure 2, the medial pubo- 
prostatic ligaments were situated at a slightly more caudal level in the floor of the 
depression between the two lateral puboprostatic ligaments. 

Upon more complete dissection it is found that the 3 ligaments (medial and lateral 
puboprostatic, and lateral true ligament of the bladder) are in reality covered by a 
thin fascia which is continuous ventrally with the fascia that forms the bottom of 
the depression between the medial puboprostatic ligaments, and dorsally with the 
remainder of the fascia endopelvina. The true ligaments are situated below this 
fascia and are of an aponeurotic nature, possessing a bluish sheen (Fig. 6). In the 
case of the medial pubovesical ligament, smooth muscle bundles are intermingled 
with the aponeurotic fibers. 

There is also a difference in relationship between the ventral ligamentous portion 
and the dorsal portion of the fascia endopelvina. By the ligamentous portion, the 
fascia is directly inserted into the bladder or prostate gland. Dorsally, it serves as a 
common anchorage line for the inferior hypogastric wing, the rectovesical septum, 
and the presacral wing. 

It has already been mentioned that the fascia endopelvina ends dorsally, opposite 
the ischial spine, in a stout arch. The fascia which closes the space between this arch 
and the inferior vesical arch contains no blood vessels and often can be broken down 
with a finger, if communication between the space of Retzius and the retrorectal 
space is desired. Moreover, the part of the fascia endopelvina extending from the spine 
of the ischium to the dorsal end of the lateral true ligament of the bladder constitutes 
an avascular area; an incision through it leads broadly into the retrorectal space. 
Both routes are indicated by rubber tubings in Figure 6. Since the fascia endopelvina 
in this avascular region is usually quite thin and affords little support to the bladder 
and rectum, cutting through it does not materially interfere with the fixation of the 
bladder, which is accomplished for the most part dorsally by the inferior vesical 
arch and ventrally by the pubovesical ligaments and the lateral true ligament of 
the bladder. 

3. The Medial and Lateral Walls and the Roof of the Space of Retzius : These will 
be discussed only briefly. The medial wall is represented ventrally by the infero- 
lateral bladder surface; dorsally, by the inferior hypogastric wing. The lateral wall 
is composed of the parietal fascia over the internal obturator and levator ani muscles. 

The superior wall or roof is represented by the superior hypogastric wing. 

The Retrorectal Space 

The retrorectal space, as mentioned above, lies between the rectum and the sac- 
rum. Dorsally, it is bounded by the parietal fascia which covers the piriformis, 
coccygeus, and levator ani muscles. Its ventral wall consists, in the cranial part of 



UHLENHUTH— FASCIAE OF MALE PELVIC CAVITY 



83 



the space, merely of the presacral wing. Farther caudally, however, where this fascia 
embraces the rectum to form the fascial capsule of this viscus, the rectum covered by 
the dorsal part of its capsule participates also in the formation of the ventral wall 
of the retrorectal space. If, in an attempt to open up the retrorectal space, one 
penetrates laterally, one arrives finally at the hypogastric root. This may be said 
to form the lateral wall of the cranial portion of the retrorectal space and which 




Fig. 14 
Retrorectal space 
Fibrous tissue which fixes the dorsal capsule of the rectum and the presacral hypogastric wing 
to the parietal fascia was broken down with a blunt instrument. Fascial shelves conducting the 
visceral nerves are displayed. 

1) Fascial capsule on dorsal surface of rectum. 2) Presacral hypogastric wing. 3) Parietal fascia. 
4) Cranial shelf. 5) Caudal shelf. 6) Bundle of visceral nerves in caudal shelf, passing to pelvic 
ganglion. 

Left half of pelvis (479 , 1950, fig. 2) of white male, 66 years of age. 



partitions this space off against the lateral compartment of the space of Retzius. 
Farther caudally, where the presacral wing attaches itself to the fascia endopelvina, 
the retrorectal space has no lateral wall but terminated in an angle formed by the 
presacral wing with the fascia of the levator ani. 

A study of the retrorectal space in a sagittally divided pelvis is of interest. By 
attempting to lift the presacral wing and the rectum away from the parietal fascia 
and from the sacrum and coccyx, one observes that the visceral fascia and the capsule 
of the rectum are firmly fixed to the parietal fascia by an abundant loose but tough 



84 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



fibrous tissue. On probing into this tissue with a spatula-probe and penetrating 
laterally, it will be found that constantly one or several fascial shelves remain. These 
arise from the parietal fascia in the vicinity of the anterior sacral foramina and pass 



■ y, ; ". - 




Fig. 15 
Pelvic ganglion 

Fibrous tissue which attaches rectum and presacral wing to parietal fascia, broken down, visceral 
nerves dissected out of fascial shelves (see Fig. 14) and followed to presacral wing. Presacral wing 
split into its two fascial leaves and pelvic ganglion dissected. 

1) Remnant of rectovaginal septum. 2) Ventral capsule of rectum and its continuation into ven- 
tral leaf of presacral wing; the latter has been cut away down to a narrow strip. 3) Dorsal capsule 
of rectum and its continuation into dorsal leaf of presacral wing; the latter has been cut down as 
far laterally as the line along which the visceral nerves enter the wing. 4) Pelvic ganglion. 5) Inferior 
hypogastric nerve. 

Right half of pelvis (479 , 1946, fig. 9) of colored female, 29 years of age. 

forward and downward to join the presacral wing and the rectal capsule. Even on 
casual inspection, a number of substantial nerve tracts are seen running in these 
fascial shelves. They are the parasympathetic branches of the sacral nerves and 
several branches from the sympathetic ganglia. Figure 14 illustrates a pelvis in 
which two such fascial shelves were present. The lower one was particularly large 



UHLENHUTH— FASCIAE OF MALE PELVIC CAVITY 85 

and well developed. In it, the visceral nerves were arranged into a wide band-shaped 
bundle and were visible even before any further dissection was made. 

In Figure 15, a female pelvis is shown in which the individual nerves enclosed in 
these fascial shelves have been dissected out. They were followed from their origin 
to the pelvic ganglion which they are seen to join. The two layers of the presacral 
wing were separated from one another and the ganglion was exposed. The pelvic 
ganglion lies embedded in the presacral wing, close to the lateral attachments of this 
wing. Its cranial tip lies about at the level of the ischial spine. The illustration shows 
that the nerves for the urogenital tract are given off from the cranial parts of the 
ganglion. They pass into the inferi&r wing and are conducted in that part of the 
visceral fascia to the uterus and bladder in the female. In the male they go to the 
seminal vesiclas, ampullae of vasa deferentia, prostate and bladder. In Figure 7, 
two stout visceral nerves are seen as they enter the inferior hypogastric wing to be 
conducted to the urogenital organs. The nerves for the rectum arise from the caudal 
portion of the ganglion, pass into the space between the fascial capsule and the 
muscular wall of the rectum, and are distributed from there to the wall of the rectum. 

The Author wishes to acknowledge his indebtedness to Dr. Albert E. Goldstein through whose 
generous interest the American Urological Association and private donors have contributed funds 
which made available the artistic assistance of Mr. William E. Loechel. 

BIBLIOGRAPHY 

1. Cameron, John: The fascia of the pelvis. Jr. Anat. and Phys., XLII, 112-125. 1908. 

2. Denonvilliers : Anatomie du perinee. Bull, de la Soc. Anat. de Paris, II, 105-107. 1836. 

3. Derry, Douglas E.: On the real nature of the so-called "pelvic fascia," Jr. Anat. and Phys., 

XLII, 97-106. 1908. 

4. Lowsley, Oswald Swinney and Kirwin, Thomas Joseph: Clinical Urology, 2nd edition, Wil- 

liams and Wilkins, Baltimore, 1944. 

5. Peham, H. v. and Amreich, I.: Gynaekologische Operationslehre, S. Karger, Berlin, 1930. 

(Also available in an American translation by L. Kraeer Ferguson, J. B. Lippincott, Phila- 
delphia, 1934.) 

6. Smith, G. Elliot: Studies in the anatomy of the pelvis, with special reference to the fasciae 

and visceral supports. Jr. Anat. and Phys., XLII, 198-218. 1908. 

7. Uhlenhtjth, Eduard, Wolfe, Walter M., Smith, E. Milton, and Mdjdleton, Edmund B.: 

The rectogenital septum. Surg., Gynec. & Obst., LXXXVI, 148-163. 1948. 

8. Young, Hugh H. and Davis, David M.: Young's Practice of Urology. Saunders Company, 

Philadelphia, London, II, 420, 1927. 

FOOTNOTES 

1 Among the 60 illustrations which have been collected so far, we owe the great majority to Doc- 
tor Edmund B. Middleton who holds the rare record of combining in one single person the enthu- 
siasm of a student, the skill of an anatomist and the gift of an artist. 

2 In a male pelvis dissected most recently, however, the supragenital septum was fully §" thick, 
composed of strong fibrous tissue and of some fat. 

3 In one case (479 , 1949, colored male, 75 years of age) which was anomalous in several other 

respects, this septum consisted of two strong lamellae, between which a space of nearly \" width 
was enclosed. Each lamella was the continuation of the inferolateral bladder capsule of the corre- 
sponding side and was continued into the parietal fascia on the pelvic wall. In the area between 
the lines of origin of the two lamellae from the bladder, the surface of this viscus was completely 
naked, the muscle being freely exposed. It is probable that this septum consists also under the 
usual conditions of two lamellae, but cannot be split because of its thinness. 



THE RELATION BETWEEN pH CHANGES AND RABBIT GUT MOTILITY 

IN VITRO *f 

LEAH MILLER PROUTT, B.S., E. RODERICK SHIPLEY, M.D., ROBERT H. 
OSTER, Ph.D. and J. EDMUND BRADLEY, M.D. 

The general qualitative effect of pH variation on the activity of smooth muscle has 
been well established (1-7). In the present work, quantitative measurement of 
pH changes in relation to rabbit gut motility in vitro as modified by various agents 
including several beverage syrupsj have been made to determine the degree of corre- 
lation between these two variables. 

The possible importance of pH and its effect on smooth muscle motility in vivo 
was indicated by the recent clinical observations of one of the authors (J. E. B.) 
on the use of a beverage syrup and a glucose phosphoric acid syrup in epidemic vomit- 
ing of children (8, 9). Gorman et al (1) have demonstrated that hydrochloric acid 
inhibits or arrests contraction of isolated gastric muscle of the rabbit and that 
sodium citrate and sodium bicarbonate restore the tonus. Evans and Underhill (3) 
have noted that smooth muscle is very sensitive to alterations in the hydrogen ion 
concentration and that a lowering of the hydrogen ion concentration causes an in- 
crease in tonus and an increase in rate of rhythmic contractions, and a raising of the 
hydrogen ion concentration causes the opposite effect. The data obtained in the 
present study include simultaneous pH measurements and smooth muscle motil- 
ity as measured by contraction rate in the presence of various agents used to alter 
the pH. 

During the early stages of the experiment, it was noted that the specific gravity 
definitely affected the amplitude of smooth muscle contraction in vitro. In Table I 
may be seen a comparison between amplitude and contraction rate as modified by 
specific gravity changes using control solutions. Because of the wide fluctuation of 
mean amplitude values, as compared with the narrow contraction rate value range, 
the latter was selected as the indicator of pH effects on smooth muscle activity. 
Since sugar was present in beverage syrups, rigid control of specific gravity was not 
possible. Table I presents the mean values of all the effects of control solutions on 
gut motility. 

MATERIAL 

A rabbit in the fasting state was killed by a blow at the base of the brain, im- 
mediately eviscerated and the intestinal sections were flushed several times with 
Tyrode's solution,. (10) then placed in clean Tyrode's and kept under constant 
aeration at 12-20 degrees C., with frequent changes of the solution. 

METHOD 

A modified Magnus technic (5) was used. Intestinal sections one to one and one- 
half inches long were cut, and mounted in the muscle chamber with as little handling 

* From the Department of Physiology, School of Dentistry, and Department of Pediatrics, 
School of Medicine ; University of Maryland, Baltimore, Maryland. 
t Received for publication November 30, 1950. 
\ The beverage syrups were kindly supplied by the National Carbonated Beverage Company. 

86 



PROUTT ET AL.—IL4BBIT GUT MOTILITY 



87 



as possible. Two sutures were used on each end of the section, in order to insure 
holding the lumen of the gut open. One end was attached to the standard in the 
muscle bath, and the other to the muscle lever. The temperature was automatically 
controlled at 39.5 degrees C, ± 0.5 degrees C. and aeration with room air was 
constant. The muscle section was at all times immersed in 100 cc. of solution, the 
major portion of which was Tyrode's solution and the final volume of the muscle 
bath was kept constant at 100 cc, since any agent added to the bath was compen- 
sated for by a withdrawal of a corresponding amount of Tyrode's. The muscle 
section was washed with fresh Tyrode's at 39.5 degrees C. after each experimental 

TABLE I 

The effect of the control solutions on rabbit gut motility, showing the individual and mean values of 
per cent change of experimental from the normal 







AMPLITUDE 




RATE OF CONTRACTION, 
PER MIN. 




pH 


SOLUTIONS 






















Spec. 
Grav. 


nor. 


change 


% diff. 


nor. 


change 


% diff. 


nor. 


% diff. 






mm. 


mm. 














Tyrode's 


1.008 


76 


76 





13 


13 





7.02 


-0.2 




1.008 


40 


40 





11 


11 





7.505 







1.006 


6 


9 


33 


12.5 


10.5 


16 


8.92 


-1.0 




1.008 


9 


10 


10 


10.8 


10.8 





8.00 


5.0 




1.008 


11 


13 


18 


11.5 


10.5 


-9 


8.00 


-1.0 




1.008 


13 


12 


-13 


10.5 


10.0 


-5 


7.80 


1.0 




1.008 


15 


15 





13 


13 





7.72 


0.3 


Mean 








20 to -13 






— 5 




3 to -5 


Sugar, 3% 


1.015 


59 


34 


-42 


13 


11 


-15 


7.42 


-0.3 


Sugar, 2.7% 


1.014 


76 


38 


-38 


13 


11 


-15 


7.00 


-0.2 


It 


1.014 


53 


35 


-34 


10 


8 


-20 


7.86 


-0.7 


It 


1.014 


40 


6 


-85 


15 


14 


-6.5 


7.77 


1.0 


it 


1.016 


40 


16 


-60 


11 


11 





7.50 


0.5 


it 


1.014 


18 


5 


-72 ■ 


10.5 


10.5 





7.42 


2.0 


a 


1.014 


12 


5 


-56 


10.0 


9.5 


-9.5 


7.88 


1.0 


a 


1.014 


9.6 


5.3 


-45 


12.5 


11.5 


-8 






a 


1.015 


17 


8.6 


-50 


12 


12 





7.75 


1.0 


Mean 








-56 






-9.3 




1 to -0.5 



step, and fresh solutions were used for each experimental step. Muscle contractions 
were recorded on a constant speed kymograph drum, and the rate of contractions 
could be accurately calculated at any spot on the record by using the simultaneously 
recorded time of one mark per second. The pH readings were taken simultaneously 
with muscle contraction change by the use of a glass electrode, in situ, immersed 
next to the muscle section in the tissue bath, and read with a Beckman electronic 
pH meter. 

SOLUTIONS 



The solutions used and their initial pH are given in Table II. 



88 BULLETIN OF THE SCHOOL OF MEDICINE, V. OF MD. 

DISCUSSION 

It should be noted that the isolated muscle strips were immersed in the test solu- 
tions in such a manner that both the serous coat and, to a much less degree, the 
mucous membrane were in direct contact with the solutions. The changes that oc- 
curred upon altering the pH were the result of the solutions contacting both surfaces, 
but the absorption across the mucous membrane obviously played a minor role. 
Magee and Southgate (7) have shown that motility of isolated rabbit and cavy 
intestines were unaffected by varying the hydrogen ion concentration, from 1.5 to 

TABLE II 

Experimental solutions used to determine the ejfect of varying pH on rabbit gut motility 



0.0165% HC1 

0.192 H3PO4 

8.5 H 3 P0 4 

25.0 Sugar 

2.84 Na 2 HP0 4 .... 

2.0 NaHC0 3 

A cola syrup 

B cola syrup* 

Citrus syrup 

Kola (1 ) syrup 

Kola (2) syrup 

Kola (3) syrup 

Kola (4) syrup 

Lemon syrup 

Orange syrup 

Grape syrup 

Ginger Ale syrup gold 
Ginger Ale syrup pale 

Root Beer syrup 

Coca leaf extract (Merck) 
Kola nut extract (Lilly) t- 



INITIAL pH 



0.82 
1.12-2 
1.02 
6.58 

8.96 
8.72 
1.58 
1.88 
1.56 
1.80 



(id 



56 

70 
86 
25 
38 
90 
45 
22 
10 
6.02 
5.52 



* A and B cola syrups are samples from soft drink fountain supplies of Coca-Cola and Pepsi 
Cola syrups. 

t We are indebted to Eli Lilly and Company for the kola nut extract. 



9.6 within the lumen, but when the mucous membrane was destroyed, increased 
acidity resulted in a marked depression of motility. 

In experimental results on in vivo preparations, the depression of gastric motility 
in correlation with an increase in the hydrogen ion concentration has been found by 
many investigators (12, 13, 14), but evidence for a similar effect on tissue of the 
small intestine is difficult to find. 

The observation of this correlation between pH change and intestinal motility 
confirms many previous reports and further presents the correlation graphically 
(Fig. 1). It is felt that the pH data obtained simultaneously with muscle activity 
changes by the in situ electrode, and the variety of agents employed to change the 



PROUTT ET AL.— RABBIT GUT MOTILITY 



89 



pH make it possible to present quantitative evidence for the correlation in the form 
of a scatter diagram. 

The increase in hydrogen ion concentration, giving a lower pH, which stimulated 
tone and then decreased contraction rate if continued, gave aspects which were 
reversed by a decrease in hydrogen ion concentration, resulting in a higher pH. 
Alkalinity at first stimulated the gut and increased the amplitude, then decreased 
the contraction rate if continued to excess. This decrease in contraction rate with 
fiber shortening was observed by McSwiney and Norton (6), who capably summarized 





Fig. 1. The distribution of values obtained on rabbit gut motility effects of numerous agent 
used to vary pH are shown in a scatter diagram. The linear relationship of the two variables indi 
cate the positive correlation between muscle strip contraction rate and pH of tissue bath. 



these findings by saying that while moderate pH changes had the specific effects on 
intestinal motility (i.e., acidity depresses and alkalinity stimulates), the effect of 
sudden great shifts in pH is the same regardless of the direction of the hydrogen ion 
concentration change; initial stimulation, followed by marked depression. Mc- 
Swiney and Norton's optimum pH range for normal motility in rabbit gut was 
7.0-8.0, which was confirmed by observations of an optimum of 7.2-8.4. 

A slowing of the contraction rate occurred regardless of the acid used to lower the 
pH. Hydrochloric acid, hydrochloric acid and sucrose, phosphoric acid, phosphoric 
acid and sucrose all gave similar reductions in the rate of contraction. It was noted 



90 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



that hydrochloric acid brought about this change in less time and to a greater degree 
than phosphoric acid at approximately the same pH, and that alkaline stimulus 
following the acid effect caused greater response when the acid containing the 
phosphoric acid had been the depressing agent. The kymograph records showing 
this effect may be seen in Fig. 2. The motility depression was not significantly 
changed when the acid agent used was in sucrose solution, except when the viscosity 
of the tissue bath, determined as specific gravity, exceeded the control range of 
values. (See Table I.) 

As may be seen in the graph of Fig. 1, the contraction rate, always expressed as 
per cent change of an experimental record from a normal record, was sensitive to pH 
changes, also expressed as per cent change of experimental from the normal. This 
change followed the same direction, regardless of the agent used, i.e., increase on 
hydrogen ion concentration contributed to a decrease in motility and decreased 




+ 10 -10 

PERCENT CHANGE 



Fig. 2. Typical rabbit gut motility records show the effect of two agents used for pH change, 
hydrochloric acid and phosphoric acid. Differences in contraction rate effect over similar pH range 
may be noted. 



hydrogen ion concentration contributed to an increase in motility. The various kola 
beverage syrups used as acid agents followed the same trend, but with an added 
depressant effect beyond that possible from acidity effect alone. Kola nut and coca 
leaf extracts when used, without acid, caused a marked inhibition of contraction 
rate with only a low per cent decrease in pH. When the extracts were used in acid 
solution, the resultant values of motility depression fell outside the range of the cor- 
relation curve. (Not plotted in Fig. 1). The contraction rate inhibition was found to 
be uniformly more marked and appeared earlier when the beverage syrups* were 
used as the acid agents. This consistent change may be the result of components 
present in the beverage syrups that have further depression effect on gut motility 
than that attributed to acidity alone. In the case of kola syrup, perhaps the extracts 
of kola nut and coca leaf are responsible. 

* Beverage syrups include lemon, orange, gingerale, root beer, citrus and grape, as well as the 
kola varieties. 






PROUTT ET AL.— RABBIT GUT MOTILITY 91 

SUMMARY 

1. The effects of hydrogen ion concentration variation in acid solutions and 
beverage syrups are demonstrated on rabbit gut smooth muscle in vitro with simul- 
taneously recorded motility and in situ pH values. 

2. The distribution of the data on a scatter diagram demonstrates the linear 
relationship indicative of positive correlation. 

3. Our data confirm previous reports; within moderate range, acids inhibit and 
alkalis stimulate smooth muscle motility. 

4. Hydrochloric acid solutions have a more marked effect than phosphoric acid 
solutions at the same pH. 

5. Sodium bicarbonate and disodium phosphate have similar effects on muscle, 
i.e., stimulation of motility. 

6. Kola beverage syrups have a depressant effect on muscle motility, and show 
greater depression than may be attributable to the acid content alone, indicating 
the possible presence of other depressing agents. 

7. Stimulatedbeverage syrups, such as hydrochloric acid and sucrose, phosphoric 
acid and sucrose, depress the motility of the gut in proportion to their acidity. 
Non-kola beverage syrups have a lesser depressant effect than the kola syrups. 

BIBLIOGRAPHY 

1. Gorman, R. A., Drier, J. D., Rehfuss, M. E.: A study of the effects of acids and alkalis on 

gastric muscle strips in rabbits. Am. J. Surg. 12: 121, 1931. 

2. Evans, C. L.: The physiology of plain muscle. Physiol. Rev. 6: 358-398, 1926. 

3. Evans, C. L., Underhiix, S. W. F.: Studies on the physiology of plain muscle. J. Physiol. 58: 

58-91, 1923. 

4. Sollmann, T., Von Oettingen, W. F., Ishikawa, G.: The effects of phosphate buffers on 

intestinal movements and their interrelation with calcium. Am. J. Physiol. 87: 293-305, 
1928. 

5. Magee, H. E., Reid, C. : Studies on the movements of the alimentary canal; the effects of 

electrolytes on the rhythmical contractions of the isolated mammalian intestine. J. Physiol. 
63:97-113, 1927. 

6. McSwiney, B. A., Newton, W. H.: Reaction of the smooth muscle to the H-ion concentration. 

J. Physiol. 63: 51, 1927. 

7. Magee, H. E., Soitthgate, B. A.: Influence on intestinal movements of electrolytes in the 

lumen of isolated segments. J. Physiol. 68: 67-79, 1929. 

8. Bradley, J. E.: The treatment of epidemic vomiting in pediatric practice. J. Pediat. 33: 318- 

324, 1948. 

9. Bradley, J. E., Proutt, L. M., Shipley, E. R., Oster, R. H.: An evaluation of a carbohydrate 

phosphoric acid solution in the management of vomiting. J. Pediat. 38: 41-44, 1951. 

10. Macleod's Physiology in Modern Medicine, revised by Philip Bard: 9th Edition, 349; C. V. 

Mosby and Co., 1941. 

11. Luciani, Luigi: Human Physiology, 2: 245-248; McMillan and Co., 1913. 

12. Wolf, Stewart; Wolff, H. G.: Human gastric function, 2nd. ed. 66-89, Oxford Univ. Press, 

1947. 

13. Thomas, J. E.; Crider, J. O.: Inhibition of gastric motility associated with the presence of 

products of protein hydrolysis in the upper small intestine. Am. J. Physiol. 126: 28-38, 1939. 

14. Karr, W. G., Abbott, W. O.: Intubation studies of human small intestine. IV. Chemical char- 

acteristics of contents in fasting state, normally, and after administration of acids, alkalis 
and water. J. Clin. Invest. 14: 893-900, 1935. 



CLINICO-PATHOLOGIC CONFERENCE 

From the Case Histories, University Hospital, Baltimore 
CLINICAL HISTORY 

A 57 year old white male mechanic was admitted to the University Hospital on 
April 4, 1950, because of weakness and numbness of his left leg of one weeks' dura- 
tion. Constipation and difficulty in voiding appeared 2 to 3 days before admission. 
Acute urinary retention occurred 12 hours before arrival at the hospital. He stated 
that he had previously enjoyed good health. About 2 weeks prior to admission, he 
developed a mild cold which was characterized by a slight cough, productive of 
small amounts of white phlegm. He suffered an ache in the right ear from which pus 
drained. The patient was seen by his family physician who gave him 3 daily injec- 
tions of penicillin. The purulent discharge decreased but did not cease. 

One week before admission the patient noted sudden, tight, "girdle" pains and 
numbness of his left leg. Subsequently, he was aware of increasing weakness of his 
left leg, constipation, and increasing difficulty in voiding. There was no history of 
headache, vertigo, coma, paralysis, anaesthesia, or paraesthesia. Although this 
history was given readily, its accuracy is questioned because the patient's memory 
and intelligence were considered below normal. 

The patient's habits were indulged in moderately. He drank 2 or 3 glasses of beer 
and smoked 20 cigarettes each day. His employment had been steady for 32 years. 
Six months before admission, he sustained a low back injury after wffiich he limped. 

On admission, he appeared chronically ill. There was no evidence of weight loss 
or acute distress. There was no rash, evidence of jaundice, petechiae, or dehydra- 
tion. His temperature was 98.6 F.; pulse rate, 88 per minute; and respiratory rate, 
18 per minute. His pupils were round, regular, equal, and reactive. The fundi were 
normal. The right eardrum w r as perforated. The auditory canal was filled with a 
thick, odorless, white exudate. There was no mastoid tenderness. The nose and 
sinuses were normal. The teeth were in poor repair. Slight pharyngeal injection was 
seen. The tonsils were considered normal. There was no venous distention in the 
neck. The trachea was in the midline. There was no tug. In the right submental 
region, there was a hard, painless, freely movable eliptical lymph node of about 4 
cm. in length. The chest expanded well. The lungs resonated on percussion of the 
chest. The breath sounds were vesicular. There was no increase of retro-manubrial 
or cardiac dulness. The heart sounds were normal in rate, rhythm, and intensity. 
The systolic blood pressure was 150 mm. of mercury; the diastolic, 90. The abdomen 
was flat, symmetrical, and relaxed without tenderness. No organs or masses were 
palpable. The genitalia were normal. The anal sphincter tone was fair. There were 
no hemorrhoids. The prostate gland was moderately enlarged, soft in consistency, 
and free of masses. Feces on the examining finger were normal in appearance. There 
was no dependent edema. Pulses in the feet were good. There was no bony tender- 
ness. 

A consultant in neurology found the patient to be alert and cooperative. Hearing 
was impaired in both ears, but the impairment was greater on the right side. There 

92 



CLIN I CO-PATHOLOGIC CONFERENCE 93 

was complete anesthesia on the left side below the 10th thoracic segmental level. 
The right leg and both upper extremities were normal. Motor power was intact ex- 
cept in the left lower extremity which was weakened to such an extent that the 
patient could barely lift his heel from the bed. The deep tendon reflexes were hyper- 
active and equal in both upper and lower extremities. There was no pathologic 
reflexes. 

On admission the blood hemoglobin concentration was found to be 90 per cent. 
This fell in 1 month to 70 per cent. Moderate leucocytosis was identified. Blood 
sugar, urea nitrogen, albumin, globulin, direct and indirect bilirubin, calcium, and 
phosphorus were determined to exist in normal concentrations. Thymol turbidity 
was reported to be .94 units; blood alkaline phosphatase, .6 units; and blood acid 
phosphatase, .65 units. The plasma chlorides and carbon dioxide combining power of 
the serum was normal. Sputum specimens and gastric washings were studied for 
Mycobacterium tuberculosis, but none was found. Blood cultures were sterile. 
Cultures of material from the ear grew E. coli and staphylococcus; from the sputum. 
Diplococcus pneumonia and Streptococcus viridans. Heterophile and cold agglutinins 
were not demonstrated. A catheterized urine specimen contained 10 white blood 
cells and innumerable red blood cells. Absolute bed rest was ordered. A lumbar 
puncture was not attempted. 

A roentgenogram of the chest showed an area of increased density, measuring 
3 cm. in diameter, lying behind the right fifth rib near the periphery of the lung 
field (Fig. 1). It appeared rarefied in its superior portion. There was pleural thick- 
ening in the region of the right lateral thorax and the right interlobar fissure. The 
dorsal and lumbar vertebral bodies were normal. An area of rarefaction, 1 cm. in 
diameter, was seen in the left ileum (Fig. 2). At the junction of the inferior ramus 
of each ischium with the acetabula, there was an ill-defined area of decreased density. 
This was most marked on the right side. On April 5 definite weakness of the right 
lower extremity was noticed. The left remained about the same. 

An examination on April 6 revealed bilateral hyperasthesia at the level of the 
tenth thoracic segment. There was no spinal tenderness. There was almost complete 
anesthesia on both sides below the thoracic level. There was no muscle power of 
either lower extremity or the abdominal muscles below the umbilicus. There was 
loss of autonomic control. The reflexes were equally active in the upper extremities, 
very sluggish in the left lower extremity, and absent in the right. There was bi- 
lateral plantar extension and flexor withdrawal movements. 

Because of the progression of this illness, a laminectomy was performed. At opera- 
tion a definite lesion was not found. The operator felt that neither the bone nor the 
epidural fat in the exposed area appeared normal. Biopsies of both were taken. 
Subsequent microscopic examination found the bone and adipose tissue to be nor- 
mal. The spinal cord in the area of the laminectomy appeared white and lifeless. 
The overlying vessels were sclerotic. A catheter was easily passed up and down over 
a distance of about 6 cm. Following laminectomy, there was no improvement of 
the motor and sensory impairment. 

A neurologic examination on April 10 revealed evidence of progression of neurologic 
disease. At that time, in addition to complete paraplegia and anaesthesia, there 



94 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

was definite weakness and awkwardness of the upper extremities and hypoactivc 
reflexes. Speech was slurred, and there was some difficulty in swallowing food and 
liquid. The tongue protruded in the midline, the gag reflex was active, and the 
uvula elevated normally. Direct laryngoscopy showed approximation of the vocal 
cords to the right of the midline. 

A lumbar puncture on April 13 revealed xanthochromic spinal fluid. The intra- 
spinal pressure was normal. One hundred erythrocytes and twenty-five leucocytes 
were found in each cubic millimeter of spinal fluid. The protein concentration was 
158 mgm. per 100 cubic centimeters. 

Over the next 2 weeks, the patient's course was marked by increasing drowsiness 
and stupor. His upper extremities finally became completely paretic. During this 
period he was given penicillin and parenteral fluids. Terminally, he developed fever, 
leukocytosis, and irregular respiration with many moist rales in the chest. He ex- 
pired quietly on May 4, 1950. 

CUNICAL DISCUSSION 

Dr. M. C. Pincqffs: If this patient had complained of only weakness and numb- 
ness of his left leg, one might have thought of injuries involving the nerves of the- 
leg, but the onset of constipation, difficulty in voiding, and acute urinary retention 
indicate something involving more than the peripheral nerves or the nerve roots. 

The question is whether this infection of the respiratory tract involving the middle 
ear was a coincidence or was related to the appearance within a week or two of damage 
to the nervous system. We know that the running ear was treated with penicillin. 
The majority of infections of the middle ear are by gram-positive cocci. This makes 
one suspect that there was involvement of the mastoid cells. Such an infection 
would not respond so readily to treatment. One inquires as to the things which link 
acute upper respiratory infections with the central nervous system. You recall 
that a few cases of meningitis are preceded by acute respiratory infections. The 
meningococcus may be cultured from a nasal discharge in a case of meningitis. Re- 
member that brain abscesses not infrequently are accompanied by a middle ear 
involvement. This obviously is not brain abscess. I remember that on a number of 
occasions we have seen in this hospital staphylococcal infections followed by an 
abscess in the epidural space outside the dural covering of the spine. Such a mass 
may press on the spinal cord and produce either a paraplegia or a hemiplegia. The 
first case of this condition diagnosed and surgically treated in this country was 
reported from the University Hospital, University of Maryland. We have subse- 
quently had a special interest in extra-dural abscess of the vertebral column. As a 
result, we have a rather large series of cases recorded in this hospital. 

There is one point in the "review of systems" to which I call attention. It says 
there that there was no bone pain or tenderness. You note above, that so far as 
the legs are concerned, there is surprisingly little said about pain in the leg that 
became numb and weak. It was noted, however, that the patient had some girdle- 
like pain around his midsection. These findings urge a consideration of an epidural 
abscess. Epidural abscess is characterized usually by severe pains ellicited by pressing 



CLINICO-PATHOLOGIC CONFERENCE 95 

on the nerve roots. There is usually a history of stiff back or pain on moving the back . 
Often there is pain on coughing. The admitted total absence of pain is against that 
diagnosis. 

It is difficult to describe a tactile impression so one cannot fully appreciate the 
adjective "hard" which modifies the submental lymph node. The node was obvi- 
ously not a soft mushy one. It was probably of cartilaginous hardness which you 
note in the glands of Hodgkin's disease or leukemia. There is a degree of hardness 
which, in my experience, is always connected with either calcified glands or ones 
packed with carcinoma. Not every carcinomatous gland has that hardness; but 
when you feel a certain consistency, you can be fairly sure that it is carcinoma. 
I do not get that impression from this description. I cannot recall a special reason 
for a single very hard gland in that region. There was enlargement of other glands 
in the cervical chain. It is the non-specificity of the results of this physical examina- 
tion and the positive roentgen examination that lead some men to think that all 
that is needed is the roentgenograph. This is as ridiculous as saying that all you need 
is a physical examination. You need both. Here is confirmation of that fact. 

It is interesting to note that there was no disturbance in sphincter tone, even 
though the patient was developing a paraplegia. One might expect either hardening, 
a tighter tone, or complete relaxation. In an older man, one of the most common 
carcinomas is of the prostate gland. This malignancy has a tendency to metastasize 
to the bones of the spine and result in partial collapse of a vertebra and pressure 
on the spinal cord. This often results in paralysis. Therefore, one would want par- 
ticularly to feel the prostate. In this case, it showed no evidence of malignancy. 
Even so, malignancy of this gland cannot be dismissed. Over and over again you 
will hear of enlarged prostates that felt benign, and were classed as benign. Later, 
bone metastases appeared. In such an event, if the specimen is carefully recut, a 
small area of carcinoma will be found. Never feel sure, if prostatic malignancy is 
to be eliminated on palpation alone. 

This patient had a sensory loss and motor paralysis of approximately the same 
extent on the same side. If he had had a motor weakness on one side and sensory 
impairment on the other, hemisection by pressure would be considered. There was 
no evidence of an upper motor neuron lesion affecting the left. 

In a month's time this patient's hemoglobin fell from 98 to 70 per cent. His blood 
calcium and phosphorus concentrations were normal. Neither his alkaline phos- 
phatase nor his acid phosphatase was elevated. These are raised in any destructive 
primary lesion of bone and in cancer of the prostate with bony metastasis. 

Note that the sputum cultures were positive for diphtheria. You know that in 
the Pacific and other parts of the world, some cases of diphtheria do not have just 
pharyngeal paralysis, but also develop paralysis in the extremities. Failure to perform 
a lumbar puncture suggests that diphtheritic myelitis was not implicated. We note 
that they later changed their minds. 

Dr. Walter L. Kilby: This first film of the chest was made at the time of the 
patient's admission. One can see that his lung is quite emphysematous. There is 
pleural thickening at the apex. There are two lines representing the interlobar 



96 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

pleura of the upper and middle lobes. There is a triangular area of infiltration in 
the hilum. Just what this means I do not know. It may be fibrosis from some previ- 
ous pulmonary infection. We are always concerned with these infiltrations in the 
hilum because they might be indicative of early primary bronchogenic carcinoma. 
The very small insignificant-appearing lesions in lungs may turn out to be early 
carcinoma of the lung with widespread metastases. It does not appear to be a con- 
solidating lesion spreading out from the hilum. In this right 5th rib, there is a small, 
round, poorly circumscribed area of infiltration. In the center, there appears to be a 
small area of rarefaction. I thought it was a lung abscess. This area of infiltration 
by the 5th rib was still visible one week later. Films of the dorsal spine, the lumbar 
spine, and the pelvis failed to show erosion or rarefaction. There is calcification of 
the abdominal aorta. 

In the pelvis there were several indefinite areas of calcification. Note the small 
area of rarefaction in the ischium near the attachment to the acetabulum. This 
does not necessarily mean a metastatic lesion, but it certainly seems to be worth 
consideration. The trabeculae are not very prominent. These roentgenographic 
findings are compatible with bronchogenic carcinoma. 

Dr. M . C. Pincoffs: In the face of signs suggesting a lesion pressing on the spinal ' 
cord, it was obviously reasonable to do a laminectomy. However, at operation, 
nothing was found except a cord that appeared white and lifeless. The underlying 
vessels were sclerotic. Something had transected the cord. The operator was able 
to pass a catheter up and down over a distance of about 6 cm. The vessels were 
sclerotic. How often does one get a transection of the cord by a thrombus? Throm- 
bosis may be predisposed by arteriosclerosis, but not commonly. In vascular syphilis 
of the spinal cord, paraplegic lesions may develop. In this case a serologic test for 
syphilis was not recorded. 

Without much pain, this man had developed anesthesia of one leg and then the 
other. Within a week or so, he had trouble in his arm. After that he became stuporous 
and comatose. He had no fever, no increased cell count in his spinal fluid, no pain, 
or muscle spasm. It seems to me that all the usual things — virus infections and 
whatnot — are all unlikely. Infectious polyneuronitis, supposedly of virus origin, 
though it usually does not cause complete paraplegia, might resemble the disease 
this patient had. 

What evidence is there against carcinoma as the diagnosis in this case? There 
is no overwhelming evidence against it. There is a hard node in the neck, there are 
suspicious lesions in the pulmonary hilum, and there are radiolucent areas of bones 
that could indicate metastases. Bronchogenic is the type of carcinoma that has the 
greatest tendency to metastasize to the central nervous system. One in 10 or 15 
cases of bronchogenic carcinomas may metastasize to the central nervous system. 
Certainly, this malignancy metastasizes more commonly to the brain than to the 
cord. As a matter of fact, metastasis of carcinoma to the cord is very rare. The 
absence of pain suggests that the lesion is inside the cord and not outside pressing 
on the cord. I have seen just one such carcinoma in my lifetime. The rarity of such 
a condition is against the diagnosis of bronchogenic carcinoma, with metastasis in 
the spinal cord. 



CLIN I CO-PA T HO LOGIC CONFERENCE 



97 



Fig. 1 




Fig. 2 



98 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

Hypernephroma is a type of tumor that produces this kind of metastasis in the 
lung. It sometimes metastasizes to the central nervous system. I believe that car- 
cinoma with metastasis is a diagnosis which is feebly supported by the observations 
in this case. I think it more reasonable to conclude that this patient's illness was 
caused by an ascending myelitis. I am inclined to put carcinoma with metastases 
to the spine in second place. 

Senior Student: Is the serologic test for syphilis still unknown? 

Dr. H. R. Spencer: That is still unknown. 

PATHOLOGIC FINDINGS 

Dr. H. R. Spencer: This was the body of a fairly well developed, poorly nourished, 
56 year old white male. There was moderate atrophy of the musculature of the 
lower extremities. Decubiti were seen on both hips, heels, lateral surfaces of the 
ankles, elbows, scapular areas, and over the sacrum. A firm lymph node was palpated 
in the anterior part of the posterior triangle on the right side of the neck. There was 
a healed surgical wound in the midline of the back over the lower dorsal vertebrae. 

The abdominal viscera appeared normal in size and position. 

The pleural sacs contained no excess free fluid. The right lung was bound to the 
parietal pleura by numerous dense fibrous adhesions. The pleura of the left lung 
was smooth and glistening. Sectioning of the right lung revealed a firm yellowish- 
white tumor mass in the lower main bronchus, the mass measuring about 3 cm. in 
diameter. It partially obstructed the bronchus. A small abscess was seen in the 
right lower lobe. The left lung appeared normal. 

Except for slight sclerosis of the coronary arteries, the heart was normal. No 
unusual changes were noted in the liver, the gastrointestinal tract, or spleen. The 
kidneys were normal in size. Each was studded with tumor nodules. A yellowish 
white tumor nodule was seen in the left adrenal. The periaortic lymph nodes in 
the lumbar area were enlarged and invaded by tumor. A metastatic lesion was seen 
in the body of the third lumbar vertebrae. 

Small tumor nodules were scattered through the white and grey matter of the 
cerebellar hemispheres, in the cerebrum, and in the brain stem. The lumbar portion 
of the spinal cord was removed. Sections revealed a small tumor mass occupying 
the center of the spinal cord. The lesion occupied about 75 per cent of the cross 
section area of the cord for a distance of about 1.5 cm. Sections of the primary 
tumor in the lung and from the metastases showed a poorly differentiated adeno- 
carcinoma. 

This case is an example of the tendency of bronchogenic carcinoma to metastasize 
to the central nervous system, particularly the brain, adrenals, and bone. It also 
shows that numerous metastases may occur in cases where the primary tumor is 
small. 

ANATOMIC DIAGNOSIS 

Bronchogenic carcinoma, lower main bronchus, right, with metastases to regional 
nodes, periaortic nodes, spinal cord, brain, adrenal, kidneys and spine. 






OBSTETRICAL CASE REPORT 

From the Department of Obstetrics, School of Medicine University of Maryland 

M. S., a 26 year old, para 1-0-0-1, reported for care early in her second pregnancy. The only 
significant fact obtained in her past history was that during the first pregnancy, 5 years previous, 
it was noted that the blood pressure was moderately but persistently elevated, averaging about 136 
mm. mercury systolic and 90 mm. mercury diastolic. There was no increase in blood pressure 
during the last trimester of the pregnancy. The urine on one occasion showed a small amount of 
albumin. The eye grounds were normal. The blood chemistry was essentially normal. Labor oc- 
curred spontaneously at term and was uncomplicated. Postpartum, there was no change in the 
blood pressure. 

Following this pregnancy, she was under the care of an internist who reported a slight increase 
in the blood pressure, but no other signs or symptoms of disease except for an occasional mild 
albuminuria. When first seen in this her second pregnancy, five years later, the pressure was 140 
mm. mercury systolic and 96 mm. mercury diastolic, the physical examination being otherwise 
negative. She was observed rather closely throughout her pregnancy and followed the anticipated 
course in that there was a mid-pregnancy drop in blood pressure, followed by a rise in the latter 
weeks to a point slightly above earlier readings (146/100) with a definite albuminuria on 3 oc- 
casions. Again, labor, delivery, and puerperium were without incident; and again the postpartum 
blood pressure did not fall to any appreciable extent. Except for occasional albuminuria, all labo- 
ratory examinations were negative, but the eye grounds showed evidence of beginning arteriolar 
changes. When seen 6 weeks postpartum, the blood pressure was still 146 mm. mercury systolic 
and 100 mm. mercury diastolic. There was a trace of albumin in the urine. 

Question: What advice should be given this patient about subsequent preg- 
nancies? 

Discussion: It would appear that this is a case of hypertensive disease with early 
vessel changes and a minimum of kidney involvement. With advancing years there 
is usually a slow but definite worsening of the condition, and her life expectancy is 
probably less than normal. There have been 2 pregnancies without any discernable 
effect upon the disease either during pregnancy or later. On this basis one might be 
inclined to say that in this case the hypertensive disease was not adversely affected 
by pregnancy and that further pregnancies would cause no more damage. On the 
other hand, several recent long range studies upon groups of such patients would 
indicate that with continuing pregnancies, only half as many are alive after 10 
years as compared to those in whom pregnancy did not occur. With this in mind, 
it would probably be good preventive medicine to advise against future pregnancies. 

Much work has been done looking toward a reduction in immediate maternal 
mortality, and the results have been most gratifying, so much so that it would 
appear that we have now arrived at a point where we might expand our efforts and 
think of the long range effect of various conditions upon the life of the mother. A 
condition in which pregnancy affects longevity as greatly as hypertensive, arteriolar 
sclerotic disease appears to be affected certainly deserves serious consideration. 



99 



BOOK REVIEWS 

Eyes and Industry. Eedwig S. Kuhn, M.D. 2nd Edition, C. V. Mosby Co., St. Louis, 1950. pp. 308 
■with 151 illustrations. Price $8.50. 

The problems of industrial ophthalmology, with their many ramifications, are becoming more 
and more intricate and demand more attention as time goes on. The whole question is posed and 
answered very adequately in this concise and useful volume. The relationship between ophthal- 
mology and industry and the results consequent upon this relation are skillfully presented. A dual 
result is produced: one is economic in nature, since maximal visual acuity of any given employee, 
irrespective of his particular job, is essential if industrial efficiency and maximal output are to be 
maintained. The second result is a program designed to correct as many visual hazards as pos- 
sible and decrease to a minimum ocular injury, whatever the etiological factor may be. 

Such a dual effect is brought about only after a tremendous effort is expended conjointly by 
industrialists and ophthalmologists. The latter alone do not formulate the entire program but 
act more in a consultative capacity. 

The author shows the vital necessity of an industrial ophthalmologist in becoming not adequately, 
but perfectly, acquainted with all the industrial methods and problems in any given plant. It is 
essential that he have a working knowledge of all types of work in the plant, and what maximal 
visual acuity is necessary for any given employee. Conversely, industrialists should be taught the 
fundamentals of eye care, hazards and their prevention, protective measures, and above all, the 
visual adaptability of any given employee for his particular job. Employees not meeting the visual 
requirements for their jobs should be changed to other jobs with as much expediency as possible. 

Constant emphasis is placed upon the importance of the eye consultant being a "visual engineer"; 
at the outset, he is to make a thorough tour of the plant, noting each branch of the plant, its meth- 
ods, and the visual acuity of each employee at his job. Master charts are then made, along with a 
thorough analysis of the visual program to be formulated. Protective devices, illumination, pos- 
sible hazards, — are all noted. The author then proceeds to the way in which a visual progiam is 
laid out. 

The sections on eye corrective programs, methods of screening and testing of visual acuity of all 
employees, are carefully written, and much time is expended in the construction of these chapters. 

There is an excellent section on the medical and surgical care of industrial eye diseases, the read- 
ing of which will prove very valuable not only to the industrial ophthalmologist, but to the general 
practitioner of ophthalmology. 

The entire book is clearly and concisely written, with more emphasis on some aspects of the 
problem being given than on others, but achieving an over-all balance that intimates a full knowledge 
of the subject on the author's part, as well as a broad personal experience with industrial eye dis- 
eases. 

John C. Ozazewski, M.D. 
Physiology of the Eye, Clinical Application. Francis Heed Adler, M.A., M.D., F.A.C.S. Price 

$12. Pp. 709, with 319 illustrations. St. Louis: C. V. Mosby Co., 1950. 

The author has made a valuable contribution to all who are interested in the functioning of the 
eye and in the visual process. Although, as the title indicates, clinical applications of the funda- 
mental phenomena are made, the major emphasis is upon the relations between anatomic structure 
and function. The book is elegantly illustrated in both the anatomic and physiologic aspects. 

This reviewer is particularly impressed by the excellent treatment of the basic physiology of 
circulation of the blood, the anatomy and physiology of muscle, the nervous centers and pathways 
for voluntary movements and reflex activity, and electrical phenomena in nerves. From the funda- 
mentals, Dr. Adler then proceeds to the development of the special and clinical aspects of each 
function in its relation to vision. 

Without slighting the modern theories, the author in most cases, has adopted a judicious and un- 
biased treatment, emphasizing those concepts which have been most tested. This attitude is well 
illustrated in his brief but coherent treatment of color vision. 

100 



BOOK REVIEWS 101 

The range of the physiology of vision has become so broad that one is pleasantly surprised to 
encounter a single volume text which covers this field so completely and clearly. 

R. H. Osier, Ph.D. 
Principles and Practice of Surgery. Jacob K. Berman, Associate Professor of Surgery, Indiana 

University, School of Medicine; Associate Professor of Oral Surgery, Indiana University, School 

of Dentistry. 1378 pages; C. V. Mosby Co., St. Louis, 1950. Price $15.00. 

This newest textbook of surgery was written primarily to correlate the basic sciences and the 
fundamental principles of surgery. The first four parts are devoted to the general concepts of the 
reaction of the body to injury and includes many valuable charts and tables to supplement the 
text. The chapters on the interchange of body fluids and acid-base balance are to be highly recom- 
mended. 

The fifth part is devoted to the diseases and injuries of specific organs and systems and constitutes 
the major portion of the text. The author has emphasized the newer concepts of surgery and the 
newer operative procedures sometimes at the expense of the older and more acceptable procedures 
of surgery. The section on "Diseases of the Alimentary System" brings into one place the major 
disorders of man's digestive tract; but at times, the more common afflictions of the intestinal tube 
are described briefly while a rather rare but more interesting disease is described at length. 

Following the modern trend, fractures are discussed very briefly, that the portions of this text 
devoted to the healing of bone and to diseases of the bones are excellent. 

This text book has in one volume condensed a vast amount of knowledge of pathologic physiology 
and biochemistry pertaining to the surgical patient not collected in any one text book before. It 
is an excellent text for the experienced surgeon. 

E. Roderick Shipley, M.D. 
Surgery of the Shoulder. .4. F. DePahna, James Edwards, Professor of Orthopedic Surgery and 

Head of the Department, Jefferson Medical College, Philadelphia. 438 pages, illustrated. Phil- 
adelphia: J. B. Lippincott Co., 1950. Price: $17.50. 

This is an excellent source of information on pathologic conditions affecting the shoulder and 
the more frequently seen entities responsible for shoulder dysfunction. The author introduces his 
subject by chapters on the comparative and normal anatomy of the pectoral girdle. The abnor- 
malities and diseases of the shoulder are then clearly and order!}' presented in nine chapters fol- 
lowed by a discussion of the surgical approaches and procedures involved in this area. 

This book is outstanding in its wealth of photographs and drawings which supplement the text. 
The author has presented with the text and illustrations many studies on individuals who were 
examined during life and at autopsy. 

The shoulder is one of the rare medical texts that combines excellent organization and writing 
with superb manufacture. 

E. Roderick Shipley, M.D. 
Pathologic Physiology: Mechanisms of Disease. Edited by William A. Sodeman, M.D., 

F.A.C.P. W. B. Saunders Co. Philadelphia 1950. pp. 808. price $11.50. 

The purpose of this volume is to bridge the gap between physiology and clinical medicine, a 
goal which it achieves in admirable fashion. Dr. Sodeman has gathered a group of 25 contributors 
each of whom is a recognized authority in the field of endeavor which he covers. The book is by 
no means intended as a substitute for the usual textbook of medicine since it does not deal in a 
systematic manner with etiology, symptoms and treatment. On the other hand, it attempts, to dis- 
cuss diseases of each organ system in terms of disturbed physiology. The modern teacher of clinical 
medicine recognizes that this approach is the most successful one toward achieving a true under- 
standing of disease entities. The material covered in each section is voluminous; the concepts pre- 
sented are quite current. Probably because of spare limitations, the compression of complex data in 
as short a space as possible produces a telegraphic style which must be reviewed several times to 
become intelligible. Each section, however, is followed by a selected bibliography which permits 
the interested reader to pursue the subject in greater detail. The book can be heartily recommended 
as supplementary reading for the senior medical student, the house officer, and the practicing phy- 
sician. The publishers, as usual, have prepared an extremely attractive format. 

Milton S. Sacks, M.D. 



MEDICAL SCHOOL SECTION 

MEDICAL LIBRARY NOTES 

In the period from November 1, 1950 to February 1, 1951, the following indi- 
viduals made gifts of books and journals to the library: 

Mr. Leonard Flax Dr. H. S. Rubinstein 

Dr. Arthur M. Kraut Dr. Frank W. Hachtel 

Dr. Maurice C. Pincoffs Dr. A. F. Thompson, Jr. 
Dr. John E. Savage Dr. Margaret Ballard 

Dr. H. Boyd Wylie Dr. Donald E. Fisher 

One alumnus has made an excellent suggestion and a generous offer. He knows 
that additional copies of much used texts are always needed in the library to meet 
students' demands. Hence, he has asked for a list of texts needed in duplicate, so 
that he may furnish some of the additional copies as a gift. This is a fine and practical 
offer which will be appreciated by both students and library staff. 

The library has been fortunate in procuring a copy of the medical dissertation of 
John Beale Davidge, 1768-1829, important figure in the early history of the School 
of Medicine and University of Maryland. This thesis is dedicated to Drs. James and 
William Murray of Annapolis, with whom Davidge began the study of medicine 
before going to Edinburgh to continue his education. In accordance with the classical 
tradition, the work is written in Latin and bears the following title-page: 

Dissertation physiologica, 

de 

Causis Catameniorum. 

Auctore 

Joanne Beale Davidge, M.A.M.D. 

B irminghamiae, 
Ex Officina T. Pearson. 



MDCCXCTV 



In February, 1951, the Maryland Historical Society borrowed the Medical Li- 
brary's portrait of Dr. Nathaniel Potter by St. Memin to be included in an exhibit 
of St. Memin's work. The display of this eminent artist's productions continued 
for about two months. The portrait, owned by the Medical Library, is well known, 
having been photographed years ago by the Frick Museum in New York for display 
there. 

DRS. CATTELL AND CLUXTON TO HEAD LUTHERAN HOSPITAL 

SYMPOSIUM 

Dr. Richard Cattell of the Lahey Clinic, speaking on the subject of "Thyroid 
Surgery", will head the program of the annual Medical and Surgical Symposium 
to be held at the Lutheran Hospital on May 5, 1951, under the auspices of the 



BULLETIN OF THE SCHOOL OF MEDICIXE, U. OF MD. 



Medical Association of the Lutheran Hospital of Maryland. Dr. Harley Cluxton, 
head of the Research Division, Armour and Company, will speak on "Recent De- 
velopments in the Clinical Application of ACTH". 

While the program is as yet incomplete, other distinguished speakers include 
Dr. Richard P. Custer, Pathologist at the Presbyterian Hospital, Philadelphia. 
Dr. Custer will speak on "Certain Aspects of Leukemia and Hodgkin's Disease". 

The organization of this annual Symposium is under the direction of Dr. Pierson 
M. Checket. All interested physicians are cordially invited. Details of the program 
may be secured through the Administrative Office of the Lutheran Hospital. 

PROGRESS NOTE II 




View of extent of construction of the new Psychiatric Building as of February 1, 1951 

DEPARTMENT OF PHYSIOLOGY 

Dr. William R. Amberson has recently received a grant of $6973.56 from the L T . S. 
Public Health Seivice to continue his studies on the physico-chemical architecture 
of muscle cells. 

Dr. John I. White has been appointed Research Fellow in Physiology. 

Dr. William Amberson, Professor of Physiology and Miss Sylvia Himmelfarb 
attended the 18th International Physiological Congress in Copenhagen in August, 
1950. Dr. Amberson presented to the Congress a paper entitled "Complex Forma- 
tion in Protein Solutions Obtained by Mild Extraction of Skeletal Muscle". After 
the Congress, Dr. Amberson visited various English and continental universities, 
lecturing on his research work concerning muscle proteins. 

During the summer, Dr. D. C. Smith continued his study of the fish thyroid at 
the Lerner Marine Laboratory, Bimini, Bahamas. 

Dr. D. C. Smith, Di. Frederick Ferguson, and Dr. J. Mc. Turner gave a series 
of lectures in the fall of 1950, at the Fort Howard Veterans Hospital on the physiology 
of digestion, circulation, and the kidney. 

Dr. D. C. Smith has received a grant of $450 from the American Philosophical 
Society to support his work on the physiology of the fish thyroid. 



MEDICAL SCHOOL SECTION iii 

MERCY HOSPITAL 

The Dental Department of Mercy Hospital has recently been approved by the 
American Dental Association for Resident training in Dentistry. 

Sister M. Veronica, Superintendent of Mercy Hospital, attended the Annual 
Meeting of the Executive and Administrative Boards of the Catholic Hospital 
Association, on January 13-15, 1951, at Marillac Social Center, Chicago, Illinois. 

Dr. Charles E. Brambel, Chief of the Biochemistry Department at Mercy Hospital, 
was elected Chairman of the Maryland Section of the American Chemical Society 
for 1951. Dr. Brambel attended the Josiah Macy Junior Foundation Conference on 
Blood Clotting and Allied Problems, on January 22 and 23, at the Beekman Hotel, 
New York City. This is the fourth conference Dr. Brambel has attended. 

Dr. Allyn F. Judd, Assistant Resident Physician at Mercy Hospital, left the 
hospital November 21, 1950, for service at Tinker Air Force Base, Oklahoma City, 
Oklahoma. 

Dr. John A. Spittel, Jr., Assistant Resident Physician at Mercy Hospital, left 
the hospital November 4, 1950, for service at Sheppard Army Air Force Base, 
Wichita Falls, Texas. 

Dr. Frank J. Theuerkauf, Jr., Junior Assistant Resident Surgeon at Mercy Hospital 
reported February 3, 1951, to Fort Sam Houston, Texas to serve in the U. S. Army. 

Dr. A. Maynard Bacon, Pediatrician on the Mercy Hospital Visiting Staff, re- 
ported February 14, 1951 to Boiling Field, Washington, D. C. for service in the 
Army Air Force, as Captain. 
Recently Appointed Hospital Visiting Staff Members: 

Dr. Frank J. Ayd, Jr. Dr. Edward L. Suarez-Murias ' 

Dr. Harold P. Biehl Dr. John F. Ullsperger 

Dr. Arthur L. Davenport Dr. Lawrence R. Wharton 

Dr. Anthony F. DiPaula Dr. Samuel F. Wolf 

Dr. Burton V. Lock Dr. John D. Young, Jr. 
Dr. Walter K. Spelsberg 

Recently Appointed Mercy Hospital Resident Staff — July 1, 1951, to June 30, 1952. 
(incomplete list) 

Surgery: 

Karl A. Dillinger, M.D Resident in Surgery 

Clyde D. Thomas, M.D Associate Resident in Surgery 

Margaret L. Sherrard, M.D Senior Assistant Resident Surgeon 

Leonard G. Hamberry, M.D Junior Assistant Resident Surgeon 

William B, Rever, M.D Junior Assistant Resident Surgeon 

Sim Penton, M.D Resident in Thoracic Surgery* 

Pomeroy Nichols, Jr., M.D Junior Resident in Neurosurgery 

(July 1, 1951 to January 31, 1952) 

George W. Smith, M.D Senior Resident in Neurosurgery 

(February 1, 1952 through June 30, 1952) 

* Resident at Mercy, City and University Hospitals. Consult Dr. Brantigan regarding appoint- 
ment date. 



iv BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

Medicine: 

Howard F. Raskin, M.D Senior Assistant Resident in Medicine 

Charles R. Ireland, M.D Assistant Medical Resident 

Frank T. Kasik, Jr., M.D Assistant Medical Resident 

Paul F. Richardson, M.D Assistant Medical Resident 

Gynecology and Obstetrics: 

John A. Ferris, M.D Resident in Gynecology 

Arthur R. Fleming, M.D Resident in Obstetrics 

DEPARTMENT OF PEDIATRICS 

The Pediatric Department has shared with the Department of Gynecology 
$5,000 from the Bressler Research Fund for several research problems relating to 
endocrinology. 

Current research problems include: 

1. The effect of B-12 on growth and development of normal infants. 

2. The effect of B-12 on the growth and development of premature infants and 
its effect on the hemogram. 

3. Identification of carcinoma of the gastrointestinal tract by cytological diagnosis. 

4. The comparison of fetal and maternal diphtheria antitoxin levels. 

5. Continued work on lead poisoning with particular emphasis on the significance 
of coprophryin iii excretion. 

The Cardiac Clinic in the Pediatric Department has been approved by the Amer- 
ican Heart Association. The Cardiac Clinic is under the direction of Dr. Sidney 
Scherlis with Dr. Gibson Wells as Associate Director, and working in the Clinic 
at regular intervals is Dr. Mary Hayleck. 

DEPARTMENT OF ROENTGENOLOGY 

Dr. Robert E. Cato, Resident in Roentgenology, was called to active duty October 
6, 1950 by the Navy Department, and is now on duty at the U. S. Naval Hospital, 
Philadelphia, Pennsylvania. 

Dr. James F. Dougherty, Jr., Assistant Resident in Roentgenology, was called 
to active duty with the U. S. Navy October 21, 1950 and is now stationed at the 
U. S. Army Hospital, Camp Cooke, California. 

Dr. John Brackin, Jr., Director of the Department of Roentgenology in the U. S. 
Veterans Hospital, Fort Howard, Maryland, has recently been appointed to the 
faculty of the School of Medicine as Instructor in Roentgenology. 

Dr. Joseph C. Furnari, class of 1942, has been appointed Fellow in Roentgenology. 

EASTERN CONFERENCE OF RADIOLOGISTS 

The Eastern Conference of Radiologists met at the Lord Baltimore Hotel on 
March 8th, 9th and 10th. The following papers were given by members of the faculty 
of the School of Medicine. 

"Pelvimetry as Related to the Mid Planes", Dr. D. Frank Kaltreider 
"Discussion of Unusual Thoracic Surgical Patients", Dr. Otto C. Brantigan 
"Tuberculous Peritonitis", Dr. John Brackin, Jr. 



MEDICAL SCHOOL SECTION v 

"The Radiologist's Role in Bronchography", Dr. Charles Davidson 

"Lipomatous Hypertrophy of the Ileo-cecal Valve", Dr. Monte Edwards 

"Various Non-Vascular Lesions Seen Through or Simulating the Cardio- Vascular Silhouette on 

the P. A. Chest Film", Dr. Edward R. Dana 
"Environmental Radiation and Cancer", Dr. Frank H. J. Figge 
"The Roentgen Manifestations of Tuberous Sclerosis", Dr. John De Carlo, Jr. 
"Antibiotic Therapy of Certain Acute Pulmonary Lesions with Discussion of Their Non-Specific 

Roentgen Appearance", Dr. Theodore E. Woodward 
"Influence of Certain Gynecological Disorders on the Urinary Tract", Dr. J. Mason Hundley, Jr. 

Mr. Tucker Retires 

After completing thirty years of service Mr. John Tucker, Purchasing Agent, 
retired on February 1, 1951. 

FACULTY NOTES 

Dr. Robert E. Bauer, Instructor in Medicine, has begun organization of a long 
term project dealing with the behavior of body fluids and effusions, the study being 
conducted through the medium of radioactive phosphorous and iodine. The pro- 
gram is under the sponsorship of the Atomic Energy Committee through a grant 
in aid. 

Dr. Eduard Uhlenhuth, Professor of Anatomy, was a recent guest speaker at the 
Urological Post Graduate Seminar sponsored by the American Urological Associa- 
tion held at the University of Texas, Dallas Texas from January 29th to February 
2nd, 1951. Dr. Uhlenhuth spoke on "The Anatomy of the Genito Urinary System 
and Congenital Anomalies of the Genito Urinary System." 

Dr. Jacob E. Finesinger, Professor of Psychiatry, was recently guest speaker at 
a seminar of personnel attached to the Army Chemical Corps Medical Division at 
Edgewood, Maryland. Dr. Finesinger spoke on "Talking to People". Dr. Fine- 
singer is principal investigator for the Chemical Corps on the psychiatric and psycho- 
logic aspect of chemical warfare. 

Dr. Otto Charles Glaser, Professor Emeritus of Zoology at Amherst College' 
died at Northhampton, Massachusetts, on February 8, 1951. Dr. Glaser will be 
remembered by alumni of the College of Physicians and Surgeons where he was a 
member of the Faculty about 1905. 

NEW CLASSIFICATION OF CERVICAL CARCINOMA 

As the result of a long study by numerous professional committees, the following 
standard Classification of Carcinoma of the Cervix was adopted on the occasion of 
the International and Fourth Congress on Obstetrics and Gynecology, the classi- 
fication superseding that of the health Organization of the League of Nations in 
1937. 

The Classification is published herewith for your information. 

Stage 

Carcinoma in situ — also known as preinvasive carcinoma, intraepithelial carci- 
noma, and similar conditions. 



vi BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

Stage I 

The carcinoma is strictly confined to the cervix. 

Stage II 

The carcinoma extends beyond the cervix but has not reached the pelvic wall. 
The carcinoma involves the vagina but not the lower third. 

Stage III 

The carcinoma has reached the pelvic wall. (On rectal examination no ''cancer- 
free" space is found between the tumor and the pelvic wall.) 

The carcinoma involves the lower third of the vagina. 

Stage IV 

The carcinoma involves the bladder or the rectum, or both, or has extended 
beyond the limits previously described. 

Charles anb #eorge 

To the many medical students, visitors, attending physicians and House Staff 
who have passed through the University Hospital during the past thirty years, 
Charles and George, the two uniformed porters, became almost legendary figures 
through their exemplification of gentle courtesy, willingness and politeness. Always 
ready to offer a cheerful greeting, their long tenure and the friendly spirit they 
created placed them well at the top of the hospital family. 

Charles Newman became associated with the University Hospital in 1911 and 
George Fossett in 1924. 

On December 4, 1950, George was admitted to the Accident Room in coma, dying 
shortly therafter of a cerebral hemorrhage. Charles was admitted to the Hospital 
the same morning with acute heart failure, dying on December 21st. 

Two familiar and loyal figures for over a quarter century have thus passed. They 
will be missed by their many friends among the staffs of the University and the 
hospital. 



May 21 Monday 

May 28 Monday 

May 30 Wednesday 

June 2 Saturday 

June 7 Thursday 

June 8 Friday 

June 9 Saturday 



Academic Calendar, 1951 

Junior examinations begin 

Junior examinations continue 

Sophomore and Freshman examinations begin 

Holiday — Memorial Day 

Announcement of graduates 

Alumni Day 

Pre-commencement exercises 

Commencement 



POST-GRADUATE COMMITTEE SECTION 



POST GRADUATE COMMITTEE, SCHOOL OF MEDICTNE 

Howard M. Bubert, M.D., Chairman and Director 
Elizabeth Carroll, Executive Secretary 

Post Graduate Office: Room 600 

29 South Greene Street 

Baltimore 1, Maryland 

DO WE NEED TO TRAIN MORE PHYSICIANS? 

PAGE C. JETT, M.D., Chairman 

Committee on Rural Medicine 

Medical and Chirurgical Faculty of Maryland 

Doctors seem to be the only people who are not convinced that we need to train 
more physicians. Most students of medical care have felt that the most vulnerable 
point in the present system of medicine is the failure of the medical profession to 
anticipate and fill the ever-increasing demand for physicians. Dr. Lowell Reed of 
Baltimore, Chairman of the Surgeon-General's Committee for Medical Education, 
states, ''Out of this experience, I believe that we need a sizable increase in the number 
of doctors in order to carry on medicine in the framework of private enterprise 
which we hope to maintain." 

Physicians have argued^ that their income structure and limited hospital facilities 
will not support any more physicians, that the problem is only one of distribution 
from urban to rural communities and, further, that the efficiency of doctors has been 
multiplied by advances in medicine, transportation, and hospital services. 

This conclusion would seem to be refuted by the fact that the 79 medical schools 
in this country are training the same number of physicians they did in 1905 despite 
the tremendous growth in population, the increased demands of the armed services, 
the U. S. Public Health Service, the Veterans Administration, and research. In 
addition, a higher percentage of physicians are entering specialties, thus further 
reducing the ranks of the general practitioner to such an extent that there is scarcely 
a community in the United States which is not asking for more. Thus, the problem 
becomes one of supplying this need; however, this is rendered more difficult by the 
difference in the fees of the general practitioner and the specialist, a subject which 
will not be discussed here. 

It is felt that a better qualified general practitioner can be produced if we follow 
this plan. First, every medical school would realize an obligation to the surrounding 
community, hospitals, and physicians, and organize within its geographical and 
traffic area, a center with a regional hospital plan, embracing all rural hospitals within 
such an area. The relationship between the medical school and the area would be a 
benevolent type of advisory service supplying postgraduate education, rotating 
interns through rural hospitals, and, in unusual cases, serving to take the responsi- 
bility from the general practitioner and at the same time using these cases for teaching 
purposes in the center. 



via BULLETIN OF THE SCHOOL OF MEDICINE, U. OF AID. 

The general practitioner today receives one year of intern training. For this 
reason, one of the great deterrents to men entering rural general practice is the 
fear of having to meet serious medical emergencies without aid of consultation. 
Secondly, it is suggested that the medical schools set up a two-year residency in 
general practice so that the name of the general practitioner might be dignified 
by adequate training and so that hospital affiliation with the "center" institution, 
the first year to be spent in a general rotating internship and the second year to be 
divided between a regional hospital and the '"center's" out-patient department. 

When the deans t)f the medical schools were approached as to the means of in- 
creasing the number of doctors, they stated that a 15 per cent increase in physicians 
is being planned at the present time. This would supply 750 doctors. Their feeling 
was that they could not expand without materially impairing the quality of the 
graduate. Further, they felt that there are certain areas of the United States which 
are without a medical school, and with the increasing state medical licensure bar- 
riers that are being erected, each state, in all probability, would be forced to have 
its own medical school. The cost of increasing the number of medical students to 
an adequate figure has been estimated at approximately forty million dollars a 
year. There is no source at this time with the exception of tax-supplied funds, which 
could possibly meet this need; and the present Congressional bill for Federal support 
of medical education, with its provision for creating a professional advisory council, 
would be a safeguard from political interference in the management of our medical 
schools. 

In reviewing the Hippocratic Oath, the following is pertinent: "To reckon him who 
taught me this art equally dear to me as my parents; to share my substance with him and 
relieve his necessities if required; to look upon his offspring in the same footing as my 
own brothers, and to teach them this art, if they shall wish to learn it, without fee or 
stipulation . . . ." 

Therefore, it is suggested that each physician, as he comes to his twentieth an- 
niversary, make a pledge to his alma mater of at least one thousand dollars to be 
paid over a five-year period. In doing this, he would be fulfilling his Hippocratic 
obligation and accomplishing something to solve the needs of current medical educa- 
tion. Thereby he shows that he is cognizant of the problem and means to do some- 
thing about it. 

INDUSTRIAL MEDICINE 

The November 14, 1950 meeting of the current series of Post Graduate Lectures 
given in Hagerstown, Md., was devoted to industrial medicine. Dr. Robert Cheno- 
with presented a paper on "The Role of the Physician in Industrial Accidents," 
and Dr. Nathan B. Herman spoke on "A Survey of the Occupational Disease Situa- 
tion in Maryland." Both Drs. Chenowith and Herman are members of the Committee 
of Industrial Medicine of the Medical and Chirurgical Faculty and have been co- 
operating with the Post Graduate Committee in this venture. The meeting was well 
attended, and those present evidenced a great deal of interest in the subject matter 
presented. The possibility that similar presentations might be repeated during 
later extramural sessions would seem worthy of serious consideration. Most of 
the physicians in the State are familiar with the compensation law as it applies to 






POST GRADUATE COMMITTEE SECTION 



industrial accidents, in view of the fact that it has been in force for some 35 years. 
However, occupational diseases have been compensable only since 1939, and it 
would seem desirable for the profession at large to familiarize themselves with this 
provision. Further, they should consider the possibility that diseases under treat- 
ment might be occupational in nature. 

The Post Graduate Committee wishes to express its appreciation to Drs. Cheno- 
with and Herman and to express to this Committee of the Medical and Chirurgical 
Faculty its desire to cooperate in every possible way in disseminating information 
about this important subject. 

MARYLAND ACADEMY OF GENERAL PRACTICE 

A varied and interesting program, arranged with the Post Graduate Committee 
by Dr. Lauriston L. Keown, was presented to the Maryland Academy of General 
Practice at the University Hospital on December 7, 1950. The Committee was 
delighted with the size of the attendance, the large area represented, and the interest 
displayed. 

Officers of the Academy are: Dr. Charles F. O'Donnell, President; Dr. Irving 
Baumgartner, Secretary -Treasurer; and Drs. Paul Knotts, Nathan Needle, and 
B. B. Kneisley, Vice-Presidents. The Committee shares their hope that similar 
programs may be repeated many times in the future. 




CHOOL AND HOSPITAL PLATES 

Plates of the School of Medicine, University of Maryland, 
3 New Hospital, and the Old Hospital are available. These 
lite plates are 10 inches in diameter with black print. The 
ice is $2.50 each, plus 25 cents insurance and postage. Send 
ier, stating the plates desired, with check to Mrs. Bessie M. 
nurius, Box 123, University Hospital, Baltimore, Maryland, 
ike check payable to Nurses Alumnae Association of the 
diversity of Maryland. 



Murray-Baumgartner 

SURGICAL INSTRUMENT 
COMPANY, INC. 



EQUIPMENT AND SUPPLIES 

FOR THE 

HOSPITAL - DOCTOR - PATIENT 

RENTALS 
BEDS - LAMPS - WHEEL CHAIRS 



5 WEST CHASE STREET 
BALTIMORE 1, MD. 

SAratoga 7333 



ALUMNI ASSOCIATION SECTION 



OFFICERS 
Louis A. M. Krause, M.D., President 
Vice-Presidents 
Samuel E. Enfield, M.D. Randolph M. Nock. M.D. 

Thurston R. Adams, M.D., Secretary Simon B 

Minette E. Scott, Executive Secretary Charles 

Board of Directors Hospital Council 

William H. Triplett, M.D. Alfred T. Gundry, M.D. 

Chairman George F. Sargent, M.D. 



Louis A. M. Krause, M.D. 
Charles Re id Edwards, M.D. 
Thurston R. Adams, M.D. 
Simon Brager, M.D. 
Austin Wood, M D. 
Wethf.rbee Fort, M.D. 
Albert E. Goldstein, M.D. 
Daniel J. Pessagno, M.D. 



Louis H. Douglass, M.D. 



Nominating Committee 
Frank Ogden, M.D. 

Chairman 
Robert F. Healy, M.D. 
Ernest I. Cornbrooks, M.D. 
Frank K. Morris, M.D. 
David Tenner, M.D. 



Alumni Council 



Fred B. Smith, M.D. 
rager, M.D., Assistant Secretary 
Reid Edwards, M.D., Treasurer 

Library Committee 
Milton S. Sacks, M.D. 
Representatiics to General Alumni 

Board 
John A. Wagner, M.D. 
Thurston R. Adams, M.D. 
William H. Triplett, M.D. 
Representatives, Editorial Board, 

Bulletin 
Harry C. Hull, M.D. 
Albert E. Goldstein, M.D. 
Louis A. M. Krause, M.D. 

(ex-officio) 
Lewis P. Gundry, M.D. 



The names listed above are officers for the term beginning July 1, 1950 and ending June 30, 1951. 



AMERICAN MEDICAL ASSOCIATION MEDICAL 
EDUCATION FOUNDATION 

In December, 1950, the Board of Trustees of the American Medical Association 
created the American Medical Education Foundation, the purpose of which is to 
support medical education through distribution of voluntary contributions to schools 
of medicine on an unrestricted basis. 

The announcement of this important step was carried in a two page article in the 
February 17, 1951 Journal. 1 Since that date a revision of policy concerning con- 
tributions has been made. 2 As a further stimulus towards voluntary contributions 
from physicians, the Board of Directors of the Medical Education Foundation 
voted that individual physicians might designate the school or schools to which 
their contributions might go. All funds thus collected will be promptly acknowledged 
and will be assigned as of July 1, 1951 to the schools so designated. 

The creation of the American Medical Education Foundation offers organized 
medicine another challenge to governmental dictation for control of medical educa- 
tion. Furthermore, through a non-profit central organization it affords a physician 
an opportunity to contribute to the financial assistance of his Alma Mater or other 
schools with the knowledge that if specified, the entire contribution will revert to 
the recipient of his choice. 

Alumni of the School of Medicine will find in the American Medical Education 
Foundation another progressive and realistic move toward the defeat of the forces 

1 J. A.M. A., 145: 46, (Organization Section). 

2 J.A.M.A., 145: 648, (March 3, 1951). 



ALUMNI ASSOCIATION SECTION xi 

which would, through the use of public funds, seek to ultimately change current 
concepts of medical education. 

This Foundation has the wholehearted support of the Faculty of the School of 
Medicine and you are urged to participate in it. You may feel certain that your 
contribution will be used wisely and that every dollar will serve a most useful purpose. 

In order that your contribution may be received by the School of Medicine in time 
for inclusion in the 1951-52 budget, contributors should send their contribution to 
Dr. Donald G. Anderson, Secretary-Treasurer of the Foundation, 535 N. Dearborn 
Street, Chicago 10, Illinois, certainly before June 1, 1951. 

PRESIDENT'S LETTER 

The Alumni of our Medical School, now living, number about six thousand, prac- 
tically all of whom are actively engaged in the practice of medicine. Their loca- 
tions are as widespread as the geography of our country. However, the greater 
majority of them are along the Atlantic seaboard. This being the case, it seems to 
me they are in a position to make a helpful contribution to medicine in general and 
to our University in particular. I have the temerity to offer a suggestion in the 
name of our Alumni Association and am hopeful it will be fully considered by all 
to whose attention it may come. 

It cannot be that there are any among the group of six thousand who are not 
familiar with the shortage of nursing personnel, a condition which is widespread 
throughout the entire country. It must be equally well known that this condition 
is seriously hampering medical progress, damaging the good name of medicine, 
and denying to doctor and patient alike a service for which there is no substitute. 
With the preparedness program of our government now in process of development, 
we must expect to further deplete our roster of trained nurses by dividing generously 
with the various armed services. Who will doubt that the services will determine a 
required minimal quota of nurses and take steps necessary to get them? The method 
by which medical officer personnel was recently procured should satisfy everyone 
that necessity knows no bounds. The prospect is not bright for even the minimum 
number of available nurses needed to keep our hospitals open and operating after 
the service requirements have been satisfied. This is indeed a gloomy outlook, but 
we should take it in stride and immediately set about doing something to remedy 
it. Here is where I come forward with the previously mentioned suggestion. 

Every alumnus should be able to influence at least one qualified young woman 
of his acquaintance to embrace nursing as a profession and her life's work. A fine 
School of Nursing is among those professional schools that make up our great Uni- 
versity and one of which we have just reason to be proud. The excellence of its 
curriculum, the quality of its staff, the scope of its training, and the high standing 
of its graduates shine out as a beacon light to prospective students when its merits 
are forcefully brought to their attention. Each of our six thousand alumni should 
so completely familiarize himself with what this school has to offer that he would 
be ready and willing to explain its advantages so convincingly that applications 
for admission would far exceed the capacity not only of our school but also that 



xii BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

of our affiliated teaching institutions. If a campaign could be agreed upon and 
actually launched and each of our alumni be imbued with sufficient interest to try 
and recruit just one qualified applicant, I am satisfied the result would be not only 
astounding but also a notable contribution to the furtherance of good, practical 
medicine. To attempt to carry on in medicine without the aid of adequate nursing 
is unthinkable, but unless we loyally help develop in young women of our acquaint- 
ance a deeper interest in entering the profession, we have no other prospect. I, 
therefore, in the name of the Medical Alumni Association offer a plan and throw 
out a challenge feeling that the urgency is great, the cause worthy, and the reward 
promising. 

''There are thousands to tell you it cannot be done, 

There are thousands to prophesy failure; 
There are thousands to point out to you, one by one, 

The dangers that wait to assail you. 
But just buckle in with a bit of a grin, 
Just take off your coat and go to it; 
Just start to sing as you tackle the thing 
That "cannot be done", and you'll do it".* 

William H. Triplett, Chairman 
Board of Directors 

ALUMNI DAY PROGRAM, 1951 

Annual Alumni Day Exercises on June 7th promise to be even more interesting 
and attractive than the successful meeting of 1950. The Alumni Association this 
year pays honor to the members of the class of 1901 who will receive at the annual 
banquet their life membership in the Alumni Association and the 50-year certifi- 
cates from Dr. Louis A. M. Krause, President of the Alumni Association. 

Activities will begin at 9 A.M. with registration in the Alumni Office and in the 
rotunda of the University Hospital. From 10 A.M. until 12 noon, a Scientific Session 
has been planned which will include papers on current researches at the School of 
Medicine with Clinical Pathologic Conferences to be discussed by Drs. Pincoffs 
and Spencer. 

At 12:30 P.M., a complimentary luncheon will be served in the Gordon Wilson 
Amphitheater in the University Hospital, this to be followed at 2 P.M. by the an- 
nual business meeting of the Medical Alumni Association. 

The Alumni Honor Award for 1951 will be presented to Dr. George E. Bennett 
of the class of 1909. Dr. Bennett's address, which should be of great interest to 
those alumni who attended the School of Medicine during the years from 1905 to 
1910, is entitled "Reminiscences of the Class and Faculty of 1909". The "reunion 
classes" will no doubt hold their individual reunions from 5 to 7 P.M. 

The annual banquet this year will be held at the Lord Baltimore Hotel. The 
high spot of the program will be the presentation of the fifty year certificates to the 
class of 1901. Details of the program will be mailed to each alumnus. 

* "It Couldn't Be Done" is from the book The Path to Home by Edgar A. Guest; copyright 
1919 by The Reilly & Lee Co., Chicago. 



ALUMNI ASSOCIATION SECTION xiii 

Printed herewith is a reservation form for hotel accommodations which should 
be secured in advance through the Alumni Office. 



RESERVATION FORM 

Secretary of the Medical Alumni Association 

I will/will not be present for the Commencement Activities beginning June 
7, 1951. 

Kindly reserve a room at the Lord Baltimore Hotel single double 

Date and time of arrival 

Name Class 

Address 



CLASS OF 1941 PLANS 10TH REUNION 

Plans are now underway for a reunion of the class of 1941. The Chairman of the 
Committee for Organization is Dr. Pierson M. Checket, 1801 Eutaw Place, Baltimore 
17, Maryland. All members of the class of 1941 are urged to contact Dr. Checket 
for reservations and details of the class reunion which will be held on June 7, 1951. 

RECEIVES "UNSUNG HERO AWARD" 

Dr. Theodore E. Woodward, class of 1938, Associate Professor of Medicine, 
was recently the recipient of the McCormick and Company (Baltimore) "Unsung 
Hero Award". 

This citation established in 1940 was originally designed to call public attention 
to and to reward members of local scholastic football and lacrosse teams who had 
contributed wholeheartedly and diligently to the success of their team, but who 
had missed the headlines, thus remaining the unsung heroes of the team. 

In 1948 the award was broadened to include a prominent citizen of Baltimore, 
who, although not foremost in the public press, nevertheless contributed much 
toward his community. 

Previous recipients of this award have been George Sauer, Coach of the Naval 
Academy football team and Arthur R. Watson, Director of the Baltimore Zoo. 

In the presentation ceremony which took place on December 8, 1950, Dr. Wood- 
ward was awarded a silver tray in recognition for his extensive investigation of 
infectious diseases. The inscription on the tray reads as follows: 

"To Dr. Theodore E. Woodward 

The McCormick Company Unsung Hero Award for his personal risks and sacri- 
fices in the field of research medicine which have produced immeasurable contribu- 
tions to the welfare of mankind. 

December 8, 1950 
Baltimore, Maryland" 



xiv BULLET IX OF THE SCHOOL OF MEDICINE, U. OF MD. 

TO RECEIVE ALUMNI HONOR AWARD 

Dr. George E. Bennett, internationally known orthopedic surgeon and Adjunct 
Professor of Surgery Emeritus of the Johns Hopkins University School of Medicine, 
and a member of the University of Maryland School of Medicine, class of 1909, will 
be honored at the Alumni Day Activities on June 7th. Dr. Bennett will be presented 




DR. GEORGE E. BENNETT, class of 1909 
Photograph by Fabian Bachrach 

with a gold key and a certificate for "outstanding contribution to medicine and 
distinguished service to mankind." 

Dr. Bennett was born in Claryville, New York, on April 15, 1885. During his 
senior year in medical school, he served as intern at the University Hospital and 
following his graduation served as house surgeon at the Hospital for the Ruptured 
and Crippled in New York City. In 1914 he joined the faculty of the Johns Hopkins 
University School of Medicine and rose to the rank of Adjunct Professor of Surgery, 
which post he held from 1942 until his retirement in 1947. 



ALUMNI ASSOCIATION SECTION xv 

An internationally known authority on problems in orthopedic surgery, an emi- 
nent clinician and a noted contributor to the advancement of his specialty, his 
nomination for this high alumni honor climaxes a career which not only distinguishes 
the man but which adds dignity and prestige to the institution wherein he began 
his career. 

APPOINTED MEDICAL DIRECTOR 

Dr. Thomas S. Sexton, class of 1939, was recently appointed Medical Director of 
the Massachusetts Mutual Life Insurance Company of Springfield, Massa- 
chusetts. 




DR. THOMAS S. SEXTON 

Associate Medical Director 
Massachusetts Mutual Life Insurance Co. 



After graduating in Medicine, Dr. Sexton served as rotating intern at Mercy 
Hospital, Baltimore. He then entered the United States Army Medical Corps 
during World War II and served for four years. 

Following his separation from the Army, he was appointed Fellow in Medicine 
at the Mayo Clinic after which he joined the Medical Staff of the Massachusetts 
Mutual Life Insurance Company in 1947. 



FRATERNAL NEWS SECTION 




ALPHA OMEGA ALPHA 

The semi-annual dinner of the Beta chapter, Alpha Omega Alpha 
Honor Medical Society was held on December 8, 1950. Following the 
dinner, initiation ceremonies were held for five new members from the 
class of 1951. Dr. H. Boyd Wylie, Dean of the School of Medicine 
spoke on "Problems of Medical Education". 

The following were the new initiates from the class of 1951. 
Earl M. Beardsley Frank R. Perilla 
Nancy Blades Henry G. Reeves, Jr. 

Leo H. Ley, Jr. 

The initiation was followed by a business meeting. A policy for the election of 
alumni members was discussed and a recommendation was made to the school re- 
garding research by students. 

PHI BETA PI 

On November 19, 1950, the Alumni Association of Phi Beta 
Pi Fraternity, Zeta Chapter, elected Dr. Frank C. Marino to 
the office of president. Dr. Marino succeeds Dr. W. C. Duffy, 
who was the key figure in the reactivation of Zeta in 1947. 

The active members of Zeta administered the initiation rite 
to 27 pledges on the evening of February 10, 1951. 

A series of medical lectures has been planned for the coming 
year. Dr. Emil Novak will deliver the first lecture on the topic 
of ovarian tumors. Dates for these lectures will be announced 
at a later time. 

PHI DELTA EPSILON 

Guest speakers at the monthly scientific meetings of 
Phi Delta Epsilon recently included Drs. Louis A. M. 
Krause, Lewis Hill, Harold Himwich and Philip Bard. 
These scientific forums have been well attended by the 
student body and faculty of the School of Medicine. 
Future guest speakers will include Dr. Helen Taussig. 

Dr. Louis V. Blum, class of 1934, was recently elected 
President of the Graduate Club of Phi Delta Epsilon. 

Dr. George Greenstein, class of 1950, has been ap- 
pointed House Surgeon at the New York Hospital for 
Joint Diseases. 

Dr. Arnold Traymer, class of 1949, has been appointed Assistant Resident in 
Pediatrics at Baltimore City Hospitals beginning in July, 1951. 

Dr. Wallace Sadowsky, class of 1942, is now serving as Assistant Resident in 
Surgery at Perry Point Veterans' Hospital, Perry Point, Maryland. 

Dr. Shipley Glick, class of 1925, Assistant Professor of Pediatrics at the School of 
Medicine, has recently been elected National Grand Vice Counsel of Phi Delta Epsilon. 






OF 

THE SCHOOL OF MEDICINE 

UNIVERSITY OF MARYLAND 

VOLUME 36 July, 1951 NUMBER 3 

THE DIAGNOSIS AND TREATMENT OF THE ACUTE ABDOMEN 
L. KRAEER FERGUSON, M.D.*f 

The acute emergencies of the abdomen are the most frequent and interesting of the 
lesions with which the practicioner has to deal. His primary duty is the recognition of 
the condition as an emergency, because most emergencies can be handled easily and 
successfully if treated early. They may lead to serious if not fatal results if delay or 
procrastination is practiced. In acute abdominal disease, the doctor is often called for 
the first time at night, after a day spent in trial of home remedies, enemas, etc. It is 
inconvenient to the doctor, but lifesaving to the patient if he is seen promptly and 
not allowed to "ride over 'till morning". The practice of simply relieving pain by an 
injection of morphine and perhaps also one of penicillin, without a thorough enough 
examination to arrive at a diagnosis, may permit a simple appendicitis to go on to 
perforation or a strangulated intestine to progress to gangrene. The acute abdomen 
cannot be put off lightly. 

There are certain symptoms which indicate the probability of serious intra-ab- 
dominal trouble. Abdominal pain lasting six hours or more, especially if the patient 
was previously well, usually indicates some definite abdominal difficulty. If this is 
associated with nausea and vomiting, elevation of pulse and decreased peristalsis, 
there is good reason to believe that the difficulty may need surgical intervention, and 
hospitalization is advised. 

It is important to make a diagnosis, if possible, in every case of acute abdomen. 
This is sometimes difficult if not impossible in many cases because the symptoms of 
many conditions are very similar and the findings on examination may also be much 
alike. In such cases the diagnosis may be less important than the recognition that 
there is an acute abdominal lesion present that requires surgical treatment. Ogilvie, 
in his characteristic fashion, expresses the surgical viewpoint thusly: "Surgery, 
broadly defined, is a method of treatment by manual processes. Surgery does not, 
like medicine, look upon diagnosis as the chief expression of its art, but rather as a 
means to an end. A correct decision concerning the cause and pathology of a symptom- 

* Professor of Surgery, Woman's Medical College of Pennsylvania and Graduate School of Medi- 
cine, University of Pennsylvania, Philadelphia, Pennsylvania. 

f Read before the Baltimore City Medical Society Joint Meeting with The Section on Surgery, 
March 16, 1951. 

Received for Publication April 20, 1951 

103 



104 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF AID. 

complex is of great importance but only insofar as it points the way to correct treat- 
ment. A decision is more important than correctness because, very often in surgery, 
treatment must be immediate to be effective; and that ultimate solvent, the lapse of 
time, is apt to lead to the final court of pathological exactitude — the post-mortem 
room". I do not mean to convey the idea that any means should be ignored to arrive 
at the definitive diagnosis in acute abdominal disease, but I do want to point out that 
frequently a definitive diagnosis in acute abdominal disease can be made only by 
surgical intervention, and the important thing is to recognize this position early. 

The basis of diagnosis in the acute abdomen is a careful history and a thorough and 
complete physical examination. Roentgenology and laboratory data add to, or con- 
firm, the clinical impression gained from the history and physical examination but 
can never replace the information gained from the patient. The history gives much 
information if it is developed so as to present the symptoms in the order of their 
appearance. I prefer to obtain first the history of the present attack, in minute detail 
and then to explore the past medical history for previous attacks, other abdominal 
diseases, operations, menstrual history, etc. In analyzing the symptoms, pain is the 
most significant. The site of the first pain often gives a clue to the location of the 
lesion which may be marked by a more diffuse pain when the patient is seen by the 
doctor. The following case illustrates this statement. 

A 52 year old male was taken suddenly ill in a movie with abdominal pain in the 
left lower quadrant. He went home immediately, having vomited several times en- 
route, and was admitted to the hospital several hours later. On examination, he 
exhibited diffuse abdominal pain and rigidity, most marked in the epigastrium and 
the left lower quadrant. Air was demonstrated under the diaphragm in the roentgeno- 
graph, and a diagnosis of ruptured ulcer was made. At operation, the patient was 
found to have a ruptured sigmoid diverticulum. 

The colicky remitting pain of smooth muscle spasm is easily recognized, and the 
radiation or reference of pain to specific anatomic areas is often an aid to diagnosis. 
Testicular pain in renal and urethral lesions and the reference of pain to the angle of 
scapula in biliary colic are familiar examples. The agonizing pain associated with a 
"frozen attitude" is characteristic of the diffuse abdominal contamination of perfora- 
tion. If the abdominal pain is not localized, the lesion is usually not one demanding 
surgical care. 

Nausea and vomiting are, in themselves, not diagnostic signs and symptoms. They 
may occur with many extra-abdominal as well as intra-abdominal diseases. When 
nausea and vomiting occur with diarrhea and abdominal pain, the cause is more 
likely to be medical than surgical. The character of the vomitus may help in the diag- 
nosis. The colics usually cause vomiting of gastric contents with bile staining. Strangu- 
lation of gut or cysts often causes retching with little vomitus. The vomiting with 
obstruction is true regurgitation of gastric and later intestinal contents. 

The physical examination should be thorough and not only confined to the ab- 
domen. The simple inspection of the patient may give some indication of the under- 
lying condition. The patient writhing in attacks of colic; the tense rigidity of the 
patient with perforation; the shock-like quiet of the patient with strangulation or 
pancreatitis, and the pallor of the bleeding patient are quite characteristic. 



FERGUSON— ACUTE ABDOMEN 105 

The degree of fever helps to differentiate intra-abdominal from extra-abdominal 
causes of the acute abdomen, especially in the onset of the attack. It is rare that acute 
abdominal pain ushered in with a chill and high fever is caused by an intra-abdominal 
lesion. The lungs or genito-urinary tract should be under suspension. 

A thorough physical examination should include the throat, heart and lungs, as 
well as the abdomen. This is especially true if the symptoms are those of an upper 
abdominal lesion. 

Palpation of the abdomen probably gives the surgeon some of his most important 
information. It is best begun at an area away from the pain, to gain an impression of 
the normal, and to relieve the patient's apprehension. This is especially important in 
children. As the area of pain is approached, the patient should be encouraged to tell 
the examiner of tenderness and to differentiate degrees of tenderness, if possible. 

When palpating the abdomen, the examiner should distinguish between muscular 
rigidity, muscle guarding, muscle tension, tenderness, and rebound tenderness be- 
cause each gives somewhat different information about the underlying pathology. 

Muscular rigidity is a continuing contraction of the abdominal muscles and is an 
indication of the spread of irritation or inflammation to the underlying parietal 
peritoneum. It, therefore, indicates the site and degree of the intra-abdominal process 
in most cases. 

Muscle guarding is an involuntary contraction of the abdominal muscles when an 
area of tenderness is pressed upon. It, therefore, is of value to localize the area of the 
acute process, and it usually indicates that the process does not lie adjacent to the 
abdominal wall. 

Muscle tension is a finding elicited by a comparison of the tension on the two sides 
of the abdomen. The difference in tension may be slight, but careful examination may 
show it to be definite. This finding I have taken to result from an axon reflex, pro- 
ducing slight muscular contraction via the somatic nerves of the involved cord seg- 
ment. Increased tension may occur from either intra-abdominal or extra-abdominal 
causes. It may be associated with hyperesthesia of the abdominal wall which must be 
distinguished from deep tenderness. 

Tenderness is a subjective finding demonstrated by pressure which increases the 
tension in an area of inflammation. It is a localizing sign, and the area of maximum 
tenderness usually overlies the area of maximum inflammation. 

Rebound tenderness is a confirmatory sign by which pain is produced at an area 
of inflammation by sudden release of pressure on the abdominal wall. The sudden re- 
lease of pressure produces a sudden readjustment of intra-abdominal relations with 
increase in tension in the inflammatory process. 

In palpation of the abdomen, distinction must be made between true and voluntary 
findings. These can often be distinguished by diverting the patient's attention while 
the abdomen is being palpated. True findings are the same with repeated examina- 
tions. Voluntary (false) findings change with each examination. In general, it may be 
said that diffuse findings except when associated with true rigidity are usually indica- 
tive of a non-surgical lesion, whereas localized findings usually suggest an acute 
surgical process. 

Along with these observations, a search should be made for the presence of masses 
and palpable organs, and the effect of respiration on their movement should be noted. 



106' BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

Palpation should also include a search of the loins and costovertebral angles for 
tenderness, muscle guarding, and a palpation of the inguinal and femoral areas for 
masses and tenderness. 

Rectal and vaginal examinations may also give valuable information that should 
never be neglected in examining the acute abdomen. In rectal examination, an effort 
should be made to have the patient distinguish between the discomfort caused by the 
strange sensation of the finger in the rectum and the tenderness produced by pressure 
on an inflammatory area. I believe the most information can be obtained by examin- 
ing the patient on his back with his knees drawn up on the abdomen in what may be 
termed the foetal position. In this position, the palmar side of the index finger can 
palpate more easily the cul-de-sac, and the abdominal contents are pushed downward 
toward the examiner. In other positions, the abdominal organs tend to fall away un- 
less they are fixed. The finding of blood on the examining finger may be an added 
observation of significance on rectal examination. 

Auscultation of the abdomen gives much information. The hyperactive peristalsis 
of normal gurgling pitch is indicative of a diffuse irritation of the intestinal tract. 
Hyperactive peristalsis of high pitch is the telltale sign of the distended, usually ob- 
structed gut. Absence of peristaltic sounds points to a diffuse involvement of the 
peritoneal cavity when associated with other signs, and the degree of reduction of 
peristalsis denotes indefinitely the severity of the inflammation. Peristalsis is usually 
reflexly silenced in the early phases of strangulations such as twisted cysts or tumors, 
volvulus, and hernias. 

The examiner should be able to form at least a clinical impression with the informa- 
tion obtained from the history and physical examination. The blood count and urin- 
alysis add further light on the diagnostic problem. When positive findings are reported, 
they must be explained in the diagnosis; but in my opinion, the most reliance is to be 
placed upon the history and physical findings in making a diagnosis. Additional help 
may be obtained from roentgenographs of the abdomen and chest in certain cases. 

PRINCIPLES OF TREATMENT IN THE ACUTE ABDOMEN 

Before discussing the symptoms and treatment of specific acute abdominal diseases, 
I would like to mention two general principles that may be well applied in the treat- 
ment of any acute abdomen. 

(1) The emergency is rarely so urgent that the necessary time cannot be taken to 
prepare the patient for operation. This means a restoration of fluid and electrolyte 
balance, a typing and cross match for transfusion if it seems advisable and appro- 
priate sedation. 

(2) The operation performed should be the most simple surgical procedure which 
will deal adequately with the lesion causing the emergency. Our only responsibility at 
this time is to save the patient's life. If the operation performed can be both lifesaving 
and curative without adding to the operative risk, as an appendectomy in perforated 
appendicitis, it fulfills the requirements. On the other hand, if a curative procedure 
should increase the operative risk, as a cholescystectomy in acute gallbladder disease, 
the surgeon should keep lifesaving uppermost in his mind and delay the curative 
procedure until more ideal conditions are obtained. 



FERGUSON— ACUTE ABDOMEN 107 



INFLAMMATION 



The acute inflammations usually have a less rapid onset than many of the other 
acute abdominal conditions. They are ushered in with a short period of malaise and 
loss of appetite. At first, a mild peritoneal irritation shows itself as a periumbilical 
pain, nausea, and vomiting. As the inflammation progresses, the pain shifts to the 
area of inflammatory tension; local tenderness, muscle guarding, or rigidity are found 
on examination. 

Slight, slowly rising fever and leukocytosis complete the aspects of an acute ab- 
dominal inflammation. The problem is then to diagnose the definitive inflammatory 
lesion. 

APPENDICITIS 

This is the commonest acute abdominal inflammation and is responsible for fully 
50 per cent of all emergency abdominal operations and for almost 90 per cent of acute 
abdominal surgery in children. It must be considered in the diagnosis of any age, but 
mostly in childhood and young adult life. The symptoms and local signs of appendici- 
tis vary with the position of the appendix with relation to the cecum, surrounding 
organs, and the peritoneum. Further, the position of the appendix varies with the 
position of the cecum in its various degrees of rotation and fixation to the posterior 
abdominal wall. Thus, if the appendix lies below the normally placed cecum against 
the abdominal wall, the usual right lower quadrant pain, tenderness and rigidity are 
found. If the position of the appendix is the same but it is covered over by ileum or 
a thick omentum, the parietal peritoneum may not take part in the inflammation ; 
and although tenderness is present, rigidity is absent. An appendix lying lateral to the 
cecum gives local tenderness and rigidity in the loin and often at a higher level than 
usual. If it lies behind the peritoneal reflection so that the early stage of peritoneal 
irritation is absent, the periumbilical pain, nausea, and vomiting resulting from this 
irritation are not noted, and the first symptoms appear in the right side. When the 
appendix extends upward or lies under the liver because of non-rotation of the cecum, 
upper right quadrant signs are produced which are often confused with acute gall- 
bladder disease. When the appendix lies in the pelvis, the early pain is often epigastric 
rather than periumbilical, and abdominal tenderness may be minimal as compared to 
that elicited on a rectal examination. 

The most common differential diagnosis is between appendicitis and acute gall 
bladder disease in the upper right abdomen, and between pelvic appendicitis and pel- 
vic disease in females. 

To make the differential diagnosis between acute cholecystitis and appendicitis in 
the short fat individual is often difficult, if not impossible, even with all the historic 
facts and diagnostic findings at hand. The important thing is to recognize the acute 
abdomen that demands surgical intervention. Either condition can be taken care of 
if the incision is properly placed. 

The differentiation between pelvic appendicitis and lesions of the female pelvis is 
even more difficult and-more important because many female pelvic lesions are cured 
without operation. There are some findings that point more strongly to the pelvic 
lesions than to appendicitis. Acute pelvic inflammatory disease is really a pelvic 



108 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD 

peritonitis producing bilateral pelvic tenderness, pain on motion of the cervix, a 
more rapid elevation of temperature and blood leukocytes, and a more diffuse ab- 
dominal tenderness lower in the abdomen. The history and finding of a vaginal dis- 
charge are common. All of these are more suggestive of pelvic disease than of appendi- 
citis, and are usually absent in the latter. With all of this information at hand, I 
believe the differentiation between appendicitis and pelvic inflammatory disease in 
certain young females is the most difficult of all diagnostic problems in the acute 
abdomen. 

The occurrence of pain midway between the menstrual periods and a tendency for 
the symptoms to become less rather than worse helps to differentiate a ruptured 
graafian follicle cyst from appendicitis. Ruptured endometrial (chocolate) cysts and 
cysts twisted on their pedicles are frequently diagnosed as pelvic appendicitis. This 
is not a serious error. When the diagnosis between appendicitis and a pelvic lesion 
cannot be made with certainty, I believe the performance of a laporatomy is safer 
than a policy of watchful waiting. I have never seen any serious consequence result 
from the removal of a normal appendix in a case of pelvic inflammatory disease. 

The acute phase of regional ileitis is not infrequently confused with acute appendi- 
citis. There is a similarity of symptoms and signs; and in this instance, the differential 
diagnosis is worthwhile, because surgery can be avoided if regional enteritis is present. 

The points in the differentiation that are helpful are several. Enteritis is invariably 
known to cause a chronic diarrhea or frequent loose stools. This is infrequent with 
acute appendicitis. A tender indefinite mass in the lower right quadrant may be 
found with ileitis. This is less common in the case of early appendicitis. From a prac- 
tical point of view it is often difficult if not impossible to differentiate between acute 
appendicitis and acute regional enteritis with certainty. Under such circumstances, 
an operation should be advised. There is considerable controversy over the surgical 
procedure to be followed when one encounters a red, edematous ileum instead of an 
inflamed appendix. Some surgeons fear secondary fecal fistula if the appendix is re- 
moved in the presence of an acute ileitis. I have never seen a fistula develop following 
appendectomy with inversion of the appendiceal stump, and I believe appendectomy 
is safe unless the base of the cecum is involved. 

In childhood, it is often difficult to rule out mesenteric adenitis as a cause of lower 
right quadrant pain and tenderness. The history and findings very closely simulate 
those of acute appendicitis. In a general way, the symptoms of mesenteric adenitis 
are less acute, the pain is less marked, the tenderness less, and not quite so well local- 
ized. One can usually examine the abdomen of the child with mesenteric adenitis quite 
easily, whereas the child with acute appendicitis permits examination with reluctance 
and apprehension. With the anxious parents demanding to know if the child has 
appendicitis, I invariably recommend surgery because it is impossible to be sure 
that the process is not appendicitis and because, I believe, that the most effective 
treatment for mesenteric adenitis is appendectomy. 

I have followed many of these cases and my experience has been that appendectomy 
not only relieves the acute symptoms, but also seems to result in an improvement in 
the general health of the child. The scrawny, complaining child who is often a feeding 
problem generally seems to take a new lease on life after removal of his appendix for 
mesenteric adenitis. 



FERGUSON— ACUTE ABDOMEN 109 

The treatment of appendicitis is appendectomy. If the patient is not seen until late 
in the course of the disease when the condition is really a peritonitis or abscess, non- 
operative therapy consisting of large doses of antibiotic drugs, intravenous fluids, 
and intestinal intubation appears to give the best results. Delayed surgery to drain 
abscesses will be necessary later. 

ACUTE GALLBLADDER DISEASE 

Acute cholecystitis occurs most often in early mid-life and in the relatively obese 
patient. In the younger patient, the acute attack may be the first sign of gallbladder 
disease; but in the older patient, a history of chronic indigestion, food intolerance, and 
of attacks of biliary colic may be obtained. In almost every case, acute gallbladder dis- 
ease occurs because of impaction of a stone in the cystic duct. The initial pain in the 
right epigastrium with radiation to the back and the angle of the scapula gives way to 
a tension pain in the upper right quadrant as the gallbladder becomes distended and 
edematous. Subcostal tenderness appears more marked as the tense gallbladder is 
forced against the examining fingers by deep inspiration. If the obstruction of the 
cystic duct continues, the process may continue on to hydrops or empyema of the 
gallbladder in younger people; but in the older age group, necrosis, gangrene, and 
perforation of the gallbladder is the common course. Jaundice is present in at least one 
fourth of the cases, and the temperature and white blood count vary with the progress 
of the disease. 

In the usual case, the diagnosis is not difficult, especially if typical symptoms and a 
typical history are obtained. If the patient is seen for the first time late in the course 
of the disease, in many cases a distinction must be made between ruptured peptic 
ulcer and acute pancreatitis. Here, a detailed history of the early and of the previous 
symptoms is of considerable aid if it can be obtained. The obese gallbladder patient 
as compared to the thin ulcer type is suggestive but not diagnostic. In the early phase, 
tenderness over-shadows the abdominal rigidity in acute gallbladder disease, whereas 
the reverse is true of ruptured peptic ulcer. Roentgenographs of the abdomen in the 
erect position may show gallstones in cholecystitis or air beneath the diaphragm in 
ruptured ulcer. In late cases, where either may have progressed as far as to produce 
a local peritoneal collection, the diagnosis may be impossible because the findings are 
alike. Both diseases may be treated the same at that stage. 

The differentiation between acute cholecystitis and acute pancreatitis may be most 
difficult from a clinical point of view. They both occur most commonly in individuals 
with previous symptoms suggesting gallbladder disease. The onset of an attack of pain 
an hour or so after a meal is more typical of pancreatitis than of acute gallbladder 
disease. The more sudden the acute epigastric pain, the more persistent the vomiting, 
the more diffuse the tenderness extending across the abdomen to the left of the mid- 
line, the more the likelihood of pancreatitis than cholecystitis. So, too, the bilateral 
tenderness in the costovertebral angles, the pain in the back, and the relatively slight 
degree of muscle guarding are more suggestive of pancreatitis. The definitive diag- 
nostic study is the serum amylase, but even this may be elevated in cases of indisput- 
able cholecystitis. 

Pancreatitis is believed to be caused, in many cases, by reflux of bile in the pancre- 
atic duct. Therefore, it would appear that drainage of the biliary tree by cholecystos- 



110 BULLET IX OF THE SCHOOL OF MEDICINE, U. OF MD. 

tomy would be worthwhile in cases where the patient seemed to be getting worse and 
where a definite diagnosis could not be made because the amylase test was not avail- 
able. 

There is usually not the urgency for surgery in cases of acute gallbladder disease 
as in appendicitis, ruptured ulcer, or intestinal obstruction/Time can be taken to 
prepare these patients for operation as a rule; by gastric intubation, hydration, intra- 
venous glucose and electrolytes, and the administration of penicillin. If the patient's 
findings appear to be regressing and there is an elevation of blood amylase indicating 
an associated pancreatitis, it may be wise to delay surgery. In older patients, how- 
ever, decision for early operation is the best plan because necrosis and gangrene of the 
gallbladder occur rapidly. In addition, associated pulmonary difficulties often arise. 

No patient should be denied surgery because he is too sick. The gallbladder can be 
drained easily, if necessary, under local anesthesia. The decision as to what is to be 
done at the operation must rest with the operative findings. In a very ill patient of 
70 with an acute gangrenous gallbladder, often nothing more than drainage of the 
gallbladder and removal of the stones are indicated. It is important to remove the 
obstructing stones in the cystic duct. In most cases, these can be dislodged backward 
and removed with the other stones in the gallbladder. It often occurs that a single 
stone is obstructing the ampulla of the gallbladder. Failure to remove the obstructing 
stone results in a subsequent gallbladder sinus. If the acute gallbladder is drained 
only, it may be wise to have the patient return for cholecystectomy at a later date. 
In most patients, however, cholecystectomy can be performed and the common duct 
explored if necessary, without increasing the operative risk. Cholecystectomy can 
usually be performed more safely during the first 48 hours than later when the edema 
of the gallbladder has been replaced by fibrosis. 

PERFORATION 

A perforation of a peptic ulcer is one of the commonest, acute upper abdominal 
lesions in males. It may occur in younger people without any preceding history of 
ulcer disease as a perforation of an acute ulcer. It more commonly appears in a 
patient who has had a history of ulcer distress for many years. There is often a day or 
two of increased discomfort which precedes the appearance of sudden pain in the epi- 
gastrium. Depending upon the size of the opening, there may be a rapid leak of gas- 
tric and duodenal contents into the abdomen, or there may be a relatively small leak. 
The acid-pepsin contents which contaminate the peritoneal cavity are extremely irritat- 
ing and produce the characteristic "frozen attitude" noted in these patients. They lie 
holding themselves tense in a single position. Any movement, as turning over in bed, 
is done with such caution and evident distress that the diagnosis can frequently be 
made by simply observing the patient. Vomiting occurs as the result of the peritoneal 
irritation but is not marked, as a rule. The temperature may be subnormal at first 
and never very high. There is a definite pulse hurry. 

On examination, the typical board-like rigidity is easily demonstrated in the upper 
abdomen and in a wider area, depending on the spread of contamination. Peristalsis 
is usually markedly reduced or absent. Because of the tendency of the contaminating 
fluid to leak laterally above the colon and then downward between the ascending colon 



FERGUSON— ACUTE ABDOMEN 111 

and the lateral abdominal wall, the area of tenderness and muscle rigidity often is 
found to involve the right side of the abdomen and may be quite marked in the ap- 
pendiceal area. When the overlying liver has protected the anterior abdominal wall 
from contamination from the leaking ulcer, these findings may lead to a mistaken 
diagnosis of appendicitis. The presence of air between the diaphragm and the liver 
in roentgenograph taken in the erect position establishes the diagnosis of ruptured 
ulcer, but a negative film does not rule it out. 

The differential diagnosis between acute cholecystitis and acute pancreatitis and 
ruptured ulcer has already been mentioned. In a typical case, there should be no con- 
fusion. In a late case the diagnosis may be impossible. The important thing is to 
diagnose the acute peritonitis and to treat it. 

Perforations of peptic ulcers will respond well to simple closure of the perforation if 
the operation can be performed early. The danger is from a continuing leak with pro- 
duction of widespread peritonitis. The indication is to stop the leak and prevent the 
peritonitis rather than to treat the ulcer. The abdomen is opened through an upper 
right transverse incision, displacing the rectus muscle medially. Closure of the perfor- 
ation by plugging the opening with omentum, held in place with sutures, gives ex- 
cellent results. Aspiration of the fluids from the abdominal cavity and closure without 
drainage is a treatment of choice. Postoperatively, gastric suction, antibiotics, and 
intravenous fluids are administered until peristalsis is resumed. This is a program that 
gives a low mortality rate. The patient who still has his ulcer must be treated for it 
after recovery from perforation. 

If the patient is not seen until more than 24 hours have passed following the perfo- 
ration, the problem of the associated peritonitis over-shadows that of the perforation. 
Experience has shown that the mortality is high with surgery for diffuse peritonitis 
and that better results are obtained with a regime of continuous gastric aspiration, 
intravenous alimentation, and massive doses of antibiotics. When walling off and 
localization occur, abscesses may require drainage and more definitive surgery re- 
served for a later date. 

PERFORATED SIGMOID DIVERTICULUM 

Perforation of a diverticulum of the colon, most commonly of the sigmoid colon, 
usually occurs without any antecedent history as an acute lower abdominal pain 
associated with, nausea and vomiting. In many cases, the process is an erosion and 
eventual rupture of the diverticulum into the free peritoneal cavity, so the process is 
really a peritonitis from the onset. The redundancy of the sigmoid loop which may 
permit this structure to lie any place in the lower abdomen from the left lower 
quadrant to well past the midline toward the right, accounts for the variability of the 
point of maximum tenderness and leads to confusion in diagnosis. The fact that a 
spreading peritonitis is present from the first, explains the high fever and leukocytosis 
that occurs early in the disease. Since diverticuli are uncommon before the age of 40, 
and occur with increasing frequency after that time, the diagnosis of perforated 
diverticulum should be considered in all cases of acute lower abdominal pain in the 
older age group. 

Although any acute abdominal lesion may at times be confused with acute per- 



112 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

forated diverticulum, acute appendicitis and acute diverticulitis are the two condi- 
tions that must be most often differentiated from it. It is important to make this dis- 
tinction, if possible, because, opening the abdomen through a gridiron incision may be 
wrong if the lesion is a mis-diagnosed appendicitis. Conservative treatment may be 
employed if diverticulitis is present. There are a few points that help in the differ- 
ential diagnosis. Perforated diverticulitis is a rapid process, producing diffuse abdom- 
inal tenderness and blood leukocytosis of 15,000 to 30,000 per cu. mm. within a 
relatively few hours. The signs and symptoms are usually slower in development, 
more definitely localized, and the leukocytosis is not so marked in appendicitis. 
Diverticulitis usually is associated with signs of colon irritability, diarrhea, crampy 
pain, and left lower quadrant tenderness. These signs and symptoms usually develop 
over a period of days. If perforation and peritoneal abscess occurs, the signs become 
more marked but localized to the area of inflammation. 

There is usually no question about the necessity for operation in the acute ab- 
domen resulting from a perforated diverticulum. There is some disagreement among 
authors as to the proper way of treating these cases. We have the following rules. If 
the perforation is of a single diverticulum without inflammatory change in the bowel, 
the diverticulum may be excised or inverted and the hole in the bowel closed. A drain 
is usually inserted at the site. If the diverticulum is a part of an inflammatory mass or 
abscess, drainage is instituted. The real difference of opinion concerns the advisability 
of a complimentary colostomy or cecostomy. We believe that fecal diversion or colon 
decompression is indicated only when the lesion is associated with obstruction. 

INTESTINAL OBSTRUCTION 

The patients with intestinal obstruction usually present such typical symptoms 
early in the course of their disease that the diagnosis should not be difficult. Colicky 
pains in the abdomen, a history of no passage of feces or gas per rectum, are charac- 
teristic symptoms. When these are associated with the active high-pitched peristaltic 
sounds of a distended gut, the diagnosis is almost sure. The roentgenologic demon- 
stration of gas-filled loops of gut and the fluid levels in the erect position are prac- 
tically diagnostic. Vomiting and abdominal distention are later symptoms and they 
depend, to some extent, upon the site of obstruction. As time goes on, a diagnosis 
becomes further complicated by strangulation and interference with the blood sup- 
ply of the obstructed gut. The appearance of strangulation adds new symptoms to the 
clinical aspects, such as local tenderness, fever, and blood leukocytosis. In addition, 
the inability to take fluids by mouth, and the loss of fluid by vomiting as well as into 
the distended gut produces marked systemic dehydration with electrolyte and nu- 
tritional imbalance. In former days the dictum was preached: "Never let the sun go 
down on a case of intestinal obstruction. The longer a case of intestinal obstruction 
lives before operation, the shorter he will live after the operation." The point was 
well taken. It the patient can be operated upon and his obstruction relieved early, 
before fluid and electrolyte disturbances and vascular damage to the gut have taken 
place, the chances of early recovery are good. 

The difficulty lies in that the patient frequently is not seen until several days 
of obstruction have passed and he is already in a serious condition. 



FERGUSON— ACUTE ABDOMEN 113 

In dealing with cases of intestinal obstruction, it is important to make a diagnosis 
between obstruction of the large intestine and that of the small, because the treatment 
in somewhat different. From an analysis of 210 cases of intestinal obstruction in 
patients over 60 years of age, we were surprised to find that at least two-thirds of the 
obstructions occurring in the small gut resulted from hernias. I should judge that a 
greater percentage appear in younger age groups. Because of this high occurrence 
of strangulation of hernias as a cause of small intestinal obstruction, in every case 
of small gut obstruction, regardless of the age, the patient should be suspected of 
having a strangulated hernia. A Richter's type of hernia in the femoral opening in 
older people is a common cause of small gut obstruction. This is diagnosed with diffi- 
culty because the hernia is so small that it cannot be palpated. On numerous occasions 
even with the abdomen open, I could not palpate such a hernial mass. The important 
thing is to make the diagnosis of small gut obstruction and to operate before gangrene 
and peritonitis make their appearance. A history of previous operations, especially of 
pelvic surgery in females, and other operations requiring drainage, makes one 
consider mechanical obstructions from intra-abdominal adhesions. 

It is important to make the diagnosis of small intestinal obstruction demanding 
operation. The exact cause of the obstruction may be evident, as in a strangulated 
hernia; but in many instances, the cause may not be apparent until the abdomen is 
opened. Although it is recognized that those patients require early operation, a few 
hours spent in overcoming the electrolyte and fluid imbalance may pay great divid- 
ends. In addition, the decompression of the gut by the Miller-Abbott tube may be 
carried out at the same time. 

In operating for a small gut obstruction, except those resulting from hernia, the 
operative procedure is varied according to the condition of the patient. If this condi- 
tion is good, an exploratory laparotomy may be performed, usually through a lower 
midline incision. The collapsed small gut is picked up at the ileocecal valve, traced up- 
ward to the site of obstruction, and dealt with as the occasion demands. If gangrenous 
or non-viable gut is found, resection and primary end-to-end anastomosis has proved 
to be the most successful method of therapy in our hands. In the extremely ill patient, 
with obstruction of long duration, any general exploration of the abdomen is to be 
avoided. The only operative indication is to decompress the gut. If this can be accom- 
plished by the Miller- Abbott tube, we are justified in delaying operation. On the 
other hand, if the Miller- Abbott tube fails to pass the pylorus and advance downward 
into the small gut, it is preferable to perform a simple enterostomy by picking up and 
opening a loop of the distended gut in the lower left abdomen through a gridiron 
incision. This may be done under local anesthesia. After the gut is decompressed, the 
abdomen may later be explored and the obstruction dealt with definitively. 

Acute obstruction of the large intestine is most often caused by a malignancy, 
usually located in the left side of the distal colon. The failure of passage of gas or feces 
and the distention of the colon with gas and fluid are characteristic clinical and roent- 
genologic findings. Small gut distention may not occur if the ileocecal valve is compe- 
tent; hence, decompression by the Miller- Abbott intubation is not nearly as success- 
ful in large gut obstructions as is true in small gut obstruction. Often a carefully 
given barium enema may reveal the point of obstruction. 



114 BULLETIN OF THE SCHOOL OF MEDICINE. U. OF MD. 

The indication for treatment in small gut obstruction, as in large gut obstruction, 
is the adjustment of fluid and electrolyte balance and decompression of the colon. 
Definitive surgery must be deferred to a later date. We still prefer to decompress the 
colon by simple tube cecostomy. This may be performed under local anesthesia 
through a gridiron incision even in seriously ill patients. Although this may appear to 
be a temporary and emergency measure, it frequently happens that with decompres- 
sion the edema about the obstructing tumor subsides, and feces and gas pass the 
obstruction in two or three days. Definitive surgery should be delayed until the pa- 
tient has recovered from the effects of an obstruction. 

MESENTERIC THROMBOSIS 

Thrombotic or embolic occlusion of the mesenteric vessels presents one of the most 
striking pictures of the acute abdomen. Fortunately, it is relatively rare, and for this 
reason is misdiagnosed more often than not. The sudden onset of central abdominal 
pain which is severe and constant is the usual characteristic feature. Depending on the 
extent of the thrombosis, faintness or even shock may be present. In addition to the 
constant pain, severe exacerbations of a colicky type of pain occur with repeated 
vomiting so that the diagnosis of intestinal obstruction is usually entertained. 

Examination shows a pale restless patient with blood pressure near shock level. 
Tenderness and rigidity of the abdominal wall indicate a diffuse abdominal irritation, 
but intestinal sounds may be increased. A rectal examination may reveal blood on the 
finger, or the return of an enema may be bloody. This is almost diagnostic. 

Mesenteric thrombosis is frequently misdiagnosed as acute hemorrhagic pancreati- 
tis, ruptured ulcer, acute gallbladder disease, and intestinal obstruction. With a care- 
ful history and diagnostic studies, the mesenteric thrombosis should at least be con- 
sidered among the diagnostic possibilities. 

The clinical features are so striking that operative intervention is usually impera- 
tive as soon as the patient can be prepared. The escape of blood stained fluid as soon 
as the abdomen is opened and the appearance of the black hemorrhagic gut makes the 
diagnosis certain. Resection of the involved gut is the only hope of cure. We prefer 
end-to-end anastomosis because it takes less time and needs but one suture line. 
Exteriorization of the infarcted gut has proved unsuccessful in our hands. Post- 
operatively, anticoagulants and antibiotics help to prevent further thrombosis and 
complications of infection. 

SUMMARY 

In dealing with a patient with an acute abdomen, it is important to recognize early 
the dangerous possibilities inherent in his condition. He should be taken to a hospital 
where he can be given the benefits of thorough study and surgical consultation. It may 
be impossible to make an exact diagnosis, but it is more important to recognize that a 
surgical lesion is present. Surgical exploration should be looked upon in many cases 
as a diagnostic method as well as a therapeutic procedure. The fundamental principle 
in dealing with these acute abdominal surgical emergencies is to carry out the simplest 
operative procedure which will deal with the lesion which creates the emergency. 



PENICILLIN IN BRONCHIAL ASTHMA*f 

HOWARD M. BUBERT, M.D. 

The part played by respiratory infection in initiating asthmatic episodes and in 
prolonging them in cases primarily caused by specific agents is larger, in our opinion, 
than is usually believed. Further, it is our conviction that infection is almost solely 
responsible for those cases presenting, from time to time, intractable asthma which 
responds little, if at all, to conventional anti-asthmatic procedures usually dramatic- 
ally effective. 

The introduction of the antibiotics placed at the disposal of the profession agents 
of incalculable value in controlling infections. Those usually occurring in the respir- 
atory tract, being, as a rule, of a mixed type, are less responsive than infections with 
a susceptible organism. However, with adequate dosage, surprisingly good results 
can be obtained at times, and a significant number of respiratory infections can be 
controlled sufficiently to terminate severe and distressing asthma, occurring as a 
result of such infection. 

Because the problem of controlling respiratory infection in these individuals loomed 
so large, and because the methods currently used presented disadvantages, ranging 
from the need for hospitalization to discomfort and costliness, it was our desire to 
evolve a method of treatment that would avoid these disadvantages insofar as such 
was practicable. Several criteria were established as being desirable; namely, the 
introduction of a potent drug, the use of a drug that was not excessively expensive, 
and a method of administration that involved a minimum of discomfort and in- 
convenience. 

The depository type of penicillin preparations seemed best suited for our purpose 
because, if a prolonged effect could be obtained, the number of injections required 
would be reduced. In addition, in our attempt to secure and maintain the maximum 
possible concentration of penicillin in the body of the patient, we administered 
enormous doses in the hope that their action might be further prolonged. Also, we 
desired a form of the drug that was not too expensive. It was deemed necessary to 
use a preparation that caused the least possible discomfort and the fewest possible 
untoward reactions. 

Initially, several types of penicillin were used. These consisted of a procaine peni- 
cillin in peanut oil, aluminum penicillin by mouth, and a "fortified" procaine peni- 
cillin in peanut oil to which was added penicillin G. In addition, and in a few cases, 
a depository type penicillin which required more frequent administration was given; 
but the added number of doses plus the discomfort resulting soon caused us to 
abandon this material. It seemed to offer no advantages, but to offer distinct dis- 
advantages. Likewise, the number of untoward reactions occurring from the use of 
crystalline penicillin, in our experience, caused us to avoid these preparations. 

* From the Section of Allergy, Department of Medicine, University of Maryland School of Medi- 
cine. 

Shirley W. Correll, Technician, assisted in this study. 
t Received for Publication January 12, 1951. 

115 



116 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

As will be shown later in this study, more and more reliance was placed upon the 
procaine penicillin that gave the most prolonged action because it seemed to us 
definitely more effectual, caused few, if any, local reactions, and few untoward re- 
actions of a general nature. The aluminum penicillin, within a very narrow field, 
seemed to be of value although many times it was not effectual, and resort to the 
most frequently used type was necessary. 

Initially, it was our hope that properly selected cases would respond with pro- 
longed relief to a course of this antibiotic, arbitrarily given at a set time. These 
cases, along with a group of untreated cases studied as controls, were observed over 
a period of months. Careful chest examinations and vital capacity estimations were 
done periodically, and the bacterial flora of the sputum was repeatedly determined. 
However, no changes of significant importance resulted in these cases except for the 
immediate improvement experienced during the period of therapy. 

Because we were dissatisfied with these results, this method was discontinued; 
and we shifted the emphasis of our study toward the prevention and treatment of 
acute respiratory infection. Cases were selected because the patient was in the midst 
of an acute respiratory infection associated with bronchial asthma, or because their 
history showed a marked tendency to have asthma whenever an acute respiratory 
infection was contracted. 

Our method was to have patients report to the office or clinic promptly when res- 
piratory infection occurred. If (after careful consideration of their history, questioning 
as to the immediate infection, temperature readings, and chest examination) bron- 
chitis was found, they were given penicillin. A further requirement was that asthma 
be present or that its occurrence be likely, in view of our past experience with the 
patient under consideration. 

If these criteria were satisfied, the drug was administered in one of the following 
ways. 

Depo-Penicillin:* 1,200,000 units (4 cc.) were injected into the buttock and re- 
peated every 3 or 4 days for several doses until the infection was controlled or until 
the procedure seemed to be ineffectual. In children, the doses were reduced pro- 
portionately to their age with 600,000 units (2 cc.) being the minimum dose given. 

Aluminum Penicillin:^ Originally these cases were given a course of 32 tablets, 
50,000 units per tablet, over a period of 4 days in an effort to duplicate the total 
number of units in the injectable material administered at any given time. However, 
we found that it did not control the infections adequately; consequently, the number 
of doses was increased to 5, the fifth dose being given during the night. 

Depo-Penicillin {Fortified):* This drug was administered in 1 cc. doses (400,000 
units) when a respiratory infection occurred and was repeated every three days for a 
total of three doses, if such was necessary. 

Our results were classified as Good, Fair, and Poor. "Good" indicates that an 
episode of bronchitis and asthma was terminated promptly; if bronchitis was present 
alone, then it was terminated and asthma did not occur. "Fair" indicates definite 

* Generous quantities of this drug were supplied by the Upjohn Company; Kalamazoo, Michigan 
t Generous quantities of this drug were supplied by Hynson, Westcott, and Dunning; Baltimore. 
Maryland. 



BU BERT— PENICILLIN IN BRONCHIAL ASTHMA 



117 



improvement that would not have been expected in a given patient when the past 
history of that patient was given critical consideration. "Poor," obviously, represents 
a failure to abort or to terminate asthma in the face of a given infection. 



TABLE 1 



Depo-Penicillin (300,000 u/cc.) 

Depo-Penicillin (Fort.) (400,000 

u/cc.) 

Aluminum Penicillin (50,000 u/tab.) 



NO. OF 


NO. OF 


CASES 


EPISODES 


50 


68 


16 


17 


14 


14 



AVG. DOSE 



GOOD 
RESULTS 



3.5 cc. 

1 cc. 
32 tabs./ 
course 



47 

9 
6 



FAIR 
RESULTS 



10 

3 
3 



POOR 
RESULTS 



11 

5 
5 



Consideration of the foregoing figures reveals that the plain, unfortified, deposit 
type of penicillin achieved good results in 69 per cent of 68 episodes. Fair results 
occurred in 15 per cent of 68 episodes, and poor results in 16 per cent of 68 episodes. 
With the fortified type deposit penicillin, 17 episodes were treated with definitely 
smaller total dosage as advocated by the manufacturer. Here 53 per cent good 
results were obtained; 18 per cent fair results; and 29 per cent poor results. With the 
aluminum penicillin by mouth, 14 episodes were treated with 43 per cent good results; 
21 per cent, fair results; and 36 per cent, poor results. Attention is called to the fact 
that in these latter cases, the "good" results obtained occurred in children with one 
exception. 

It seems obvious from these findings that the method under discussion, namely, 
large doses of a plain, deposit type penicillin, represents the method of choice. 

Because hospitalized cases usually represent severe, intractable asthma that the 
attending physician has been unable to control at home, it was thought worthwhile to 
compare hospital admissions, comparing two successive twelve-month periods. Our 
experience here is as follows. 

TABLE 2 

February 1, 1948 — February 1, 1949 

Our Cases 24 (Avg./month — 2) 

All Other Cases 66 (Avg./month— 5.5) 

Total 90 

February 1, 1949 — February 1, 1950 

Our Cases 11 (Avg./month — 0.9) 

All Other Cases 36 (Avg./month— 3) 

Total... ' 47 



It will be noted that our cases were reduced in number 54 per cent, and the ad- 
missions of all other physicians in the same hospital, 45 per cent, showing a 9 per 
cent greater reduction in our cases. The overall reduction in admissions of severe 
asthma was 47 per cent. Furthermore, from the experience shown by all cases of 
severe asthma admitted, it is obvious that antibiotics have probably accounted for 
the more favorable total admission rate experienced in the latter year shown above. 



118 BULLET IX OF THE SCHOOL OF MEDICINE, U. OF MD. 

Parenthetically, it may be mentioned that, occasionally, we encountered cases of 
asthma unresponsive to penicillin. In these, it was our practice to resort to the use of 
other antibiotics. In some instances, they have proved effectual. However, their 
greater cost, together with the tendency of one of them to cause untoward reactions 
in a considerable number of patients, militates (in some degree, at least) against their 
routine utilization. 

SUMMARY 

We were interested in evolving a simple and inexpensive method of controlling 
infectious asthma with as few untoward reactions as possible. A depository type 
penicillin, in large doses, was administered to infectious asthmatics in the midst of 
respiratory infection. Fortified depository penicillin and aluminum penicillin, by 
mouth, were also utilized. 

CONCLUSIONS 

1. The method outlined would seem to be a satisfactory one for the control of a 
large percentage of episodes of infectious asthma. 

2. It would seem that the antibiotics have contributed to the reduction of asth- 
matic attacks of sufficient severity to warrant hospitalization, no matter what 
method of administration was used. 




A NEW TYPE PULL-OUT WIRE FOR TENDON SURGERY: 
A PRELIMINARY REPORT* 

ARLIE R. MANSBERGER, JR., M.D.. ERVVIN R. JENNINGS, M.D., 
EDWARD P. SMITH, JR., M.D. and GEORGE H. YEAGER, M.D. 

Basic problems in successful tendon repair are: accurate approximation of the 
severed tendon without tension, immobilization and prevention of formation of 
surrounding cicatrix. Various techniques and types of suture materials have been 
devised in an attempt to minimize surgical trauma and to reduce the use of foreign 
materials. 

To evaluate and compare results, a standard form has been adopted at the Uni- 
versity Hospital. An attempt is now being made to evaluate various methods of ten- 
don repair. It is the purpose of this paper to describe a new barbed pull-out. wire 
suture and discuss the technique for its use. 

Description 

The suture consists of a braided tantalum wire with a weldon curved cutting needle 
at the proximal end, and a weldon straight cutting needle at the distal end. It is 
approximately 42 centimeters long with a semi-flexible weldon barb approximately 
12 centimeters from the curved needle or proximal end. The barb points toward the 
distal end of the suture. The original wire of twisted stainless steel was unsatisfactory 
because of lack of pliability, f The tantalum wire suture now being used is extremely 
flexible, has excellent tensile strength, and is easily removed. % 

Technique 

After identification of the severed tendon ends, the straight needle is introduced 
through the center of the proximal segment, starting a varying distance from the cut 
end and threaded through until the barb is engaged. Engagement of the barb is 
facilitated by a slight downward pull of about 90 degrees to the direction of the tendon 
fibers. Careful engagement of the barb prevents tearing of the tendon. The straight 
needle is then threaded through the center of the distal cut tendon end for a varying 
distance and brought out through the skin. Traction on the distal end of the wire 
further engages the barb and pulls the proximal tendon distally, affording easy ap- 
proximation of the cut edges. Handling and maceration of the lacerated edges is re- 
duced to a minimum. The distal end of the wire is then fixed over a button placed 
next to the skin. Tension sufficient to maintain good approximation is exerted. 

* From the Department of Surgery, University Hospital and University of Maryland School of 
Medicine, Baltimore, Maryland. 

Received for Publication May 10, 1951 

t Developed by Dr. Med. Fritz Lengemann, an Austrian surgeon. 

% The braided tantalum barbed pull-out wires were supplied to us by the Ethicon Company. We 
wish to express our thanks to Dr. Herbert F. Davis and Mr. Zoller of the Ethicon Company for 
their cooperation. 

119 



120 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



By means of the curved cutting needle, the proximal end of the wire is brought out 
through the skin and secured without tension over a button. The wound is closed in 
lavers and the area immobilized bv external fixation. 




Tied 



Tied Tiqh+lu 




Proximal Tendon. 



Distal Tendon 



Drawing showing details of suture (left), technique of use (bottom) and view of hand with 
suture in place. 



At the end of 21 days, the distal end of the wire is cut flush with the skin and the 
wire removed by gentle traction on the proximal end. Fifteen barb pull-out wires have 
been used in 10 patients, and no difficulty has been encountered in their removal. 

This method of tenorrhaphy presents the following advantages: 

1. Simplicity. 

2. Xo tissue constrictive factors. 

3. Minimal foreign body implant with minimal tissue reaction. 



MANSBERGER, ET A L— WIRE FOR TENDON SURGERY 121 

4. Surgical trauma and maceration of the cut tendon ends is reduced to a minimum. 

5. Internal immobilization of the proximal end of the cut tendon is provided by 
means of a single suture. 

6. Removal is easy. 

Summary 

A new braided tantalum barbed pull-out wire suture and the technique for its use 
is described. 

A companionate article Tendon Forms for Use in the Treatment of Severed Tendons" by 
Erwin R. Jennings, M.D., George H. Yeager, M.D. and Otto C. Brantigan, M.D. will appear in a 
forth-coming edition of the Bulletin. 



TORULOSIS OF THE CENTRAL NERVOUS SYSTEM: BIOCHEMICAL 
BEHAVIOR OF THE CAUSATIVE ORGANISM *f 

WILLIAM H. MOSBERG, JR., M.D. and JAMES D. McALPINE, Ph.D. 

INTRODUCTION 

In 1916 Stoddard and Cutler (1) in their monograph placed the pathology and 
clinical aspects of central nervous system torulosis on a firm basis. Since that time 
the causative organism has been widely studied and extensive descriptions of its 
macroscopic and microscopic appearance and cultural characteristics may be found 
in the recent literature (2). Other investigators have clarified the life cycle of the 
organism (3), its nutritional requirements (4) and the chemical composition of the 
capsule of the organism (5). The biochemical behavior of the Cryptococcus neqfor- 
mans has remained a source of controversy. With the exception of studies made by 
Harrison (6), Fitchett and Weidman (7) and Cox and Tolhurst (2), the opinions of 
various authors have varied from "no fermentation of carbohydrates" (8, 9, 10, 
11, 12, 13, 14) to "slight if any fermentation of carbohydrates" (15, 16, 17, 18). 
In this study an attempt was made to obtain as many different strains of Crypto- 
coccus neoformans isolated from the human central nervous system as possible and 
study the reaction of these strains on a series of carbohydrate media. 

METHODS 

The material used as inoculum was obtained from the central nervous systems 
of 30 different patients who were suffering from torulosis. These subcultures were 
tested for purity by both plating and direct examination of stained smears. Cultures 
from 6 to 7 days old, growing on Sabouraud's media, served as the source for inocu- 
lating the media used in this study. 

Twenty-eight sets of media were then inoculated with each of these subcultures. 
Fermentation tests were made using 1 per cent concentrations of the carbohydrates. 
Uninoculated tubes of the various media served as standard for comparison of the 
color. All inoculations were made in duplicate. Following inoculation the media were 
incubated at 38 C. for 24 hours and, following this, kept at room temperature. Ob- 
servations were continued for 90 days. 

RESULTS 

The results obtained in the 30 strains studied are presented in Table I. It is note- 
worthy that no strain formed gas and that every strain fermented dextrose. Media 
frequently fermented in this study were sucrose, galactose, levulose, d-mannose, 
rhamnose and trehalose. No fermentation was noted on erythritol, inositol or adoni- 
tol. Each of the strains exhibited different biochemical characteristics. 

* From the Departments of Neurosurgery and Bacteriology, University of Maryland, School of 
Medicine, Baltimore, Maryland. 

Aided by a grant from the Hoffberger Neurosurgical Fund, 
t Received for publication December 26, 1950. 

122 



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q ft 


asoiovivo + l'§l+ + + + + + + + + +l + l+ + + + + + : §+l + l 1 1 

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123 



124 BCLLETIX OF THE SCHOOL OF MEDICINE— U. OF MD. 

DISCUSSION 

Harrison (6) was probably the first to divide torula and mycotorula into groups 
according to their sugar fermentations. In his study the organisms were divided into 
9 groups according to their reaction on carbohydrate media. His results were not 
confirmed by this study. 

In a comprehensive investigation Fitchett and Weidman (7) employed 20 strains 
of torula from cerebrospinal cases and found that: "dextrose and levulose were fer- 
mented by all 20 strains; dextrose and levulose alone were fermented by 7 of the 
strains; dextrose, levulose and saccharose were fermented by 4 strains; inulin, 
dextrose, levulose, saccharose and melitose were fermented by 2 strains, and these 
5 sugars and mannite by 2 strains." Weidman in an earlier paper (19) stated that the 
higher concentration of sugar in carbohydrate media seemed to hasten the reaction 
and cause a definite amount of gas to be formed in some of the sugars. 

More recently Cox and Tolhurst (2) have studied 10 strains from their cases and 
have concluded that: "The fermentative power of Torula histolytica is weak and 
variable." They suggested that the biochemical behavior varied according to the 
time which had elapsed since isolation of the organism. 

Weidman in 1933 (19) made the statement: "It appears from this that such dif- 
ferences in acid production cannot be invoked to create new species of this Torula, at 
least at the present time." This study, carried on sixteen years later and employing 
organisms isolated from many cases diagnosed since that time, confirms that opinion. 

Acknowledgments : The authors are indebted to Drs. John Wagner and Frank Hachtel for their advice and encour- 
agement and to the many laboratories and clinics for their contribution of subcultures without which this study could 
not have been undertaken. 

SUMMARY 

1. A study was made of the biochemical behavior of the organism isolated from 
the central nervous system of 30 patients suffering from torulosis. 

2. In no instance was gas formed, but each strain fermented dextrose. Other 
frequently fermented media were sucrose, galactose, levulose, d-mannose, rhamnose 
and trehalose. Erythritol, inositol, and adonitol were not fermented by any of the 
strains. 

3. Each strain studied exhibited a different biochemical behavior. 

REFERENCES 

1. Stoddard, J. L., and Cutler, E. C: Torula infection in man. A group of cases, characterized 

by chronic lesions of the central nervous system, with clinical symptoms suggestive of cere- 
bral tumor, produced by an organism belonging to the torula group (Torula Histolytica, N. 
Sp.). Stud. Rockefeller Inst. Med. Res., 25: 1-106, 1916. 

2. Cox, L. B., and Tolhurst, J. C: Human torulosis, pp. 1-142, Melbourne University Press, 

Carlton, N. 3, Victoria, Australia, 1944. 

3. Todd, R. L., and Herrmann, W. W.: The life cycle of the organism causing yeast meningitis. 

J. Bact., 32: 89-103, 1936. 

4. Schmidt, E. G., Alvarez-Dechoudens, J. A., McElvain, X. F., Beardsley, J., and Tawab, 

S. A. A.: A microbiological study of cryptococcus neoformans. Arch. Biochem., 26: 15-24, 
1950. 

5. NrNO, F. L.: Contributions to the study of the blastomycoses in the Argentine Republic. Bol. 

Inst. Clin. quir. B. Aires, 14: 591-1014, 193S. 






MOSBERG AND McALPINE— TORULOSIS 125 

6. Harrison: Quoted by 14. 

7. Fitchett, M. S., and Weidman, F. D.: Generalized torulosis associated with Hodgkin's disease. 

Arch. Path., 18: 225-244, 1934. 

8. Burger, R. E., and Morton, C. B.: Torula infection; review and report of four cases. Surgery, 

15: 312-325, 1944. 

9. Frothingham, L.: A tumour-like lesion in the lung of a horse caused by a Blastomyces (Torula). 

J. Med. Res., 3: 31, 1902. 

10. Kessel, J. F., and Holtzwart, F.: Experimental studies with torula from a knee infection in 

man. Amer. J. Trop. Med., 15: 467-483, 1935. 

11. Mitchell, L. A.: Torulosis. J. A. M. A., 106: 450-452, 1936. 

12. McGehee, J. L., and Michelson, I. D.: Torula infection in man. Surg. Gynec. Obstet., 52: 

803-808, 1926. 

13. Rappaport, B. Z., and Kaplan, B.: Generalized torula mycosis. Arch. Path., 1: 720-741, 1926. 

14. Weis, J. D.: Four pathogenic torulae (Blastomycetes) . J. Med. Res., 2: 280, 1902. 

15. Johns, F. M., and Attaway, C. L.: Torula meningitis, report of a case and summary of litera- 

ture. Amer. J. Clin. Path., 3: 459-465, 1933. 

16. Levin, E. A.: Torula infection of central nervous system. Arch. Intern. Med., 59: 667-684, 

1937. 

17. Longmire, Jr., W. P., and Goodwin, T. C: Generalized torula infection, case report with 

observations on pathogenesis. Johns Hopk. Hosp. Bull., 64: 22-44, 1939. 

18. Taber, K. W.: Torulosis in man; case. J. A. M. A., 108: 1405-1406, 1937. 

19. Weidman, F. D.: Cutaneous torulosis, the identification of yeast cells in general in histologic 

sections. South. M. J., 26: 851-863, 1933. 



GOUT— RECENT ADVANCES 
EDWARD S. McCABE, M.D.* 

The word "gout" has been adapted from the Latin etymon, gutta, which implies 
a drop or coagulation. It is descriptive of the articular dyscrasia thought to be caused 
by a defluxion of humors into affected joints. The chalky tophus is essentially a large 
accumulation of sodium urate crystals with the initial lesion a microscopic gutta of 
urate. 

Hippocrates in 400 B. C. is credited with the first recorded description of podagra 
(attacks foot, Greek) although it seems probable that Hieron recognized the malady 
prior to that. Aretaeus added much to the description of the symptom complex, and 
Alexander of Tralles made a significant advance (sixth century A. D.) with the suc- 
cessful use of colchicum autumnale. It was not until 1820 that Pelletier (1) isolated 
the alkaloid colchicine from this herb. For modern history of gout see Chart I. 

There is increasing interest in human genetics and in the early detection of car- 
riers of hereditary disease. Talbott (2) observed 136 blood relatives of 27 gouty pa- 
tients and found no roentgenologic evidence of gout. However, 25 per cent were 
found to have hyperuricemia, and 80 per cent of these were male. Steelier and later 
Freyberg came to the conclusion that hyperuricemia results from a single autosomal 
dominant gene, and only a small percentage of the heterozygotes manifest gouty 
arthritis. Thus the homozygotes are prone to go on to tophaceous gout. Also, there is 
evidence now to show that a similar relationship holds as regards hypercholesterol- 
emia and xanthoma lesions. In addition, about one-third of the patients show both 
errors in metabolism. 

The incidence of gout is roughly 5 per cent of all cases of arthritis seen at the large 
general hospitals and clinics. Thus, there are about 350,000 cases in the United 
States. Sex, age, climate, and occupation are additional predisposing factors. 

Metabolism: Purine nitrogen is excreted as urate because no enzyme is present in 
man to oxidize urate to allantoin. Uric acid is partially endogenous. About 200 
mgms. are excreted daily on a purine-free diet with an adequate caloric intake. Nu- 
cleoproteins are the principal source. The primary exogenous sources are liver, kid- 
ney, thymus, pancreas, sardines and anchovies. Of the bases, thymine, cytosine, and 
uracil are the pyrimidine bases which form urea as the nitrogenous end product. On 
the other hand, adenine and guanine (purine bases) are deaminized and oxidized to 
form hypoxanthine and uric acid. The maximum solubility of sodium urate in dis- 
tilled water is 100 mgm. per cent; but in the presence of saline, it is reduced to | or 
Yo, depending on other ions present; yet the solubility in body fluids is somewhat 
higher, and hence the existence of a colloidal form is suggested. Talbott feels that 
98 per cent of patients with gout irrespective of the phase, will show a serum 
uric acid above 6 mgms. per cent, just the reverse of a control group. In the urine 
the more alkaline it is the greater the solubility. However, for a given pH the more 
sodium ions, the less soluble are the urates. One must keep excretion at less than 50 
mgms. per 100 cc. of urine. There is a higher value in gouty subjects for the ratio, 

* 133 S. 36th Si., Philadelphia, 4, Pennsylvania 

126 



McCABE— GOUT— RECENT ADVANCES 127 

serum urate concentration _. ,. . , . , . . . . 

— : — . lhus, there may be a selective constitutional intenoritv 

urine urate concentration 

of the kidney in its ability to concentrate urate. Synovial fluid is in agreement with 

serum urate concentration. The only exception is the spinal fluid which represents 

60-80 per cent of the serum level. 

Renal clearance is calculated as the volume of plasma needed to carry the quantity 
of the substance excreted per minute. For inulin or mannitol a normal person forms 
125 cc. glomerular filtrate although only 2 per cent reaches the urinary bladder. 
Ninety per cent of urate in glomerular filtrate is reabsorbed, so that renal clearance 
is about 10 cc. per minute. Urea is about six times greater. This applies to gouty sub- 
jects as well. Urate clearance tends to be maintained at the expense of per cent re- 
absorption as glomerular filtration rate is impaired in gouty patients by progressive 
damage. Retention of urate from kidney damage is manifest only when glomerular 
filtration rate is depressed below 35 cc. per minute. 

See (3) in 1875 was the first to observe that salicylates increased urate excretion. 
It is probable that while the tubules are busily engaged in the excretion of salicylate, 
they are unable to give proper attention to resorption of urate. The action of cincho- 

CHART I 
HISTORICAL REVIEW 

SYDENHAM 1683 Differentiation of gout from other joint diseases. 

SCHEELE 1776 Identified uric acid in a kidney stone. 

WOLLASTON 1797 Discovered uric acid in tophi. 

PELLETIER 1820 Isolated colchicine from the meadow saffron. 

GARROD 1848 Discovered hyper uricemia. 

MIESCHER 1871 Nucleoproteins in cell nuclei. 

KOSSEL 1891 Purines are building stones of nucleic acid. 

FISCHER 1907 Chemical structure of uric acid and purines. 

FOLIN 1913 Method for uric acid determination in blood. 

KOCH 1939 Method for determination of "true uric acid" with uricase. 

ALDERSBERG 1942 Abnormal uric acid partition (ultra filtration). 

SMYTH 1948 Genetics of gout and hyper uricemia. 

HENCH 1949 Pituitary Adrenocorticotropic Hormone. 

phen is probably the result of a mildly toxic activity to the renal tubular cells. Colchi- 
cine has no demonstrable effect in urate clearance. Salygan® does have an effect as 
does Diodrast®, p-amino hippuric acid and Caronamide®. Glucose at high plasma 
levels takes precedence over urate reabsorption. 

There appears to be a gout cycle starting with a diminished excretion of urate; then 
a gain in body weight accompanied by diuresis. A drop in barometric pressure pre- 
cedes the latter. Harkary (4) recently emphasized the allergic aspect of the chemical 
manifestations with the joints as the major shock tissue. Experiments in the rat 
have shown (Selye) that anaphylactic reactions from egg white can be inhibited by 
injections of ACTH and cortisone, while Desoxycorticosterone acetate (D.O.C.A.) in- 
creases the mortality. Also formaldehyde arthritis can be minimized or exaggerated by 
the above agents. The hypo-activity (5) of the adrenal cortex with reference to the 
11 oxysteroids in the prodromal period may be responsible for release of inhibition 



128 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



of the xanthine oxidase in the liver and hence to rise to serum uric acid (Chart II). In 
phase 4, despite innumerable liver function tests, the only consistent abnormality is 
a high blood fibrinogen which would account for the increased sedimentation rate. 
The low keto steroid excretion may be caused in part by an unsuccessful attempt to 
convert to 11 oxysteroids. 

Urate Deposition: The fact that the earliest changes observed at microscopic ex- 
amination of joints are deposits of urate in the upper layer of cartilage, suggests 
that urate comes from synovial fluid rather than directly from the capillaries of bony 
structures. Focal necrosis is unlikely because of the long span of life and synovitis, 
unless allergic, is not seriously entertained. Urate deposits are prone to develop in 
avascular tissues with the exception of the kidney. Fibrous ankylosis may follow ex- 
tensive erosion and destruction of the cartilage. A tophus has 60 per cent urate, 30 
per cent organic material, and 10 per cent cations, mainly sodium. It may be as- 
sumed that urate deposits in apposition to bony trabeculae inhibit osteoblastic ac- 
tivity; and as bone is resorbed normally, it is not replaced in the immediate vicinity 
of a tophus. The exostoses are characteristic of degenerative joint disease and may 
be associated with calcium deposition but are not necessarily a part of gouty joints. 





CHART 11 


FIRST 


STAGE 


Phase 1 


Phase 2 


ARTHRITIS Early attacks of 


Later and more fre- 


acute recurrent 


quent attacks but 


arthritis 


still complete re- 




missions. 


HYPERURICEMIA 




Transient 


+ 


+ 




TOPHI Generally absent 


+ 





— 



SECOND STAGE 

Phase 3 Phase 4 

Residual joint disease. 

Exacerbations or Late, relatively 

active chronic ar- painless, inactive 

thritis. residual arthritis. 



+ + 



+ 



+ + 



+ + 
ulceratim 



Gout would appear to be the result of an inborn error of metabolism, which at 
some time or other manifests itself as a hyperuricemia and/or gouty arthritis. The 
tophaceous form and chronic arthritis is more likely to be seen in the individual 
with a double gene defect (6). Certain factors involved in endogenous uric acid me- 
tabolism are (1) diminished destruction, (2) diminished excretion, and (J) increased 
formation. The last would appear the most likely if a threshold is exceeded, over- 
taxing the first two factors. It appears that the alarm reaction precipitated by emotion, 
infection, surgical procedures, and drugs, i.e. liver extract, physical exertion, allergy 
and alcohol or dietary indiscretion with the resulting outpouring of steroid hormones, 
especially if dissociation with D.O.C.A. in preponderance is possible, will disturb 
metabolism enough to account for all symptoms. An allergic factor on a consti- 
tutional diathesis may be the synergist that magnifies small changes in the 

desoxycorticosterone . _,. , ,„. , , . . . , , ., 

—-■ — — — — ratio, I itch (/) has shown verv nicelv that svnovial permeabil- 
11 oxysteroid 

ity is increased by D.O.C.A. and hyaluronidase and that cortisone, artisone, and other 



McC. 1 BE— GOUT— RECENT A D YA NCES 



129 



11 oxysteroids decrease permeability. It has been shown before that any increase in 
sodium ions at a given pH necessarily decreases urate solubility. Thus, since the 
pituitary is probably under "hormostatic control", a large single dose (8) such as 50 
mgms. of adrenocorticotropic hormone (A.C.T.H.) may ameliorate acute gout by 
creating a more favorable ratio since it stimulates primarily the mid zone or oxyster- 




Fig. 1. (Top) : Roentgenograph showing mild gouty arthritis of hand 
Fig. 2. (Bottom) : Roentgen photograph showing advanced gouty changes 

oids, thus helping mainly at the many sites of inflammation or by covering the lag 
period until the D.O.C.A. falls low enough to again stimulate the pituitary. 

The first attack (Stage I) of acute gouty arthritis usually occurs suddenly, lasts 
about 3 to 10 days, and then disappears completely. It affects a great toe or with al- 
most equal frequency an instep, ankle, knee, or other region. The typical attack may 






130 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

come on at night and the pain, moderate at first, increases in severity. Often the 
weight of the bedclothes adds to the patients' distress. On examination the affected 
joint is swollen and exquisitely tender. The skin is a deep color, almost purplish, and 
veins are prominent. There is often local itching and some desquamation as swelling 
subsides. Hyperuricemia may or may not be present. 

The disease usually increases in tempo and severity, attacks coming semi-annually 
or more often. Later attacks (Stage II) are prone to be polyarticular and febrile. 
Despite this, the joints recover full symptomless function. The stage of chronic gouty 
arthritis begins after a variable period of time, i.e., ten years or so. At first, exacerba- 
tions are superimposed with incomplete remissions. Then these cease, and there 
exists a relatively painless chronic arthritis. At some time all the patients with ex- 
acerbations show a hyperuricemia, but in the chronic stage the sedimentation rate 
is a much better guide as to activity than the uric acid level which is within normal 
limits. With the polyarticular stage, subcutaneous tophi and involvement of bursae 
are rather common. Osseous tophi may be demonstrated in chronic gouty arthritis. 
Fig. 1 and2. 

One aspect (9) of this disease that has not been emphasized enough is the mental 
side. This is more frequently seen in phase 3 of the disease when the patient's memory, 
especially, for recent events, is impaired, as is the ability to calculate. The speech 
then becomes thick, garbled, or slurred. The individual may become quite irritable. 
This does not appear to be on a toxic drug basis, as the clinical signs disappear while 
the patient is still under therapy. 

Complications may arise in the cardiovascular-renal system. Nephritis and renal 
colic occur in about one-fifth of the cases in the second stage. It would appear that 
degenerative vascular complications are more frequent in gout, especially when asso- 
ciated with arteriosclerosis. The differential diagnosis would therefore include rheu- 
matoid arthritis, osteoarthritis, intermittent hydroarthrosis, menopausal arthritis, 
palindromic arthritis, and erythema nodosum. 

Treatment: The important points in treatment are an early recognition and pro- 
phylaxis which includes demonstration of symptomless hyperuricemia. The early 
monarticular attack may be aborted by taking a saline cathartic and the use of 
colchicine, gr. j-^-, every 2 hours for 6 or more doses. This may be followed by so- 
dium salicylate gr. XX 4 times daily or cinchophen gr. VII ss 3 times daily for a 
few days to combat hyperuricemia. If the attack becomes established, bed rest with 
a cradle to keep the weight of the bed clothes from the affected part is needed and 
should be maintained until pain and tenderness subside. Warm compresses are usually 
more effective than cold. The colchicine must be pushed to toxic dose level although 
once this is known, on subsequent attacks the patient may stop a few tablets short 
of the toxic level. Paregoric or codeine may be necessary to control the diarrhea result- 
ing from colchicine. Aldersberg (5) believes that colchicine lowers the bound uric acid. 
It seems that one could use the difference in the determinations of spinal fluid uric 
acid and serum uric acid as the protein-bound portion and thus easily prove the 
validity of this hypothesis with simultaneous determinations before and after insti- 
tution of therapy. 

At times a narcotic as strong as morphine gr. j may be necessary to relieve the 



MCCABE— GOUT— RECENT ADVANCES 131 

pain of gout. The diet should be low in purines and fats and high in carbohydrate. 
Alcohol should be avoided. Cocoa which contains theobromine is preferable to tea 
and coffee as the latter yield uric acid. 

The fact that the patient has a gouty diathesis and must adhere faithfully to the 
interval treatment needs to be stressed. The diet may be individualized but should 
be free of purines 3 days a week and low (200 mgms.) on other days. If an allergic 
background is evident, then those substances should be avoided at all times. There 
seems to be evidence that an increased vitamin requirement exists, particularly 
thiamine demands. Acetylsalicylic acid gr. XX three times daily, alternating with 
Chlor-Trimeton® -A mgm. three times daily, seems to be a useful interval regimen. 
The gouty patient should always carry a few colchicine tablets along for prompt use 
as necessary. 

Cinchophen® therapy is a calculated risk since it is very effective in lowering 
serum uric acid. It is necessary to maintain a good urinary output, i.e., 1500 cc. 
daily, and to insure an alkaline urine. Potassium Citrate gr. XX three times daily 
may be used in order to prevent precipitation of urates bringing about renal colic. 
The cases of liver damage from cinchophen appear to have occurred in cases of rheu- 
matoid arthritis that were misdiagnosed. In chronic gouty arthritis fever therapy, 
using typhoid vaccine may be required. If tophaceous ulcers occur, a careful debride- 
ment usually results in prompt healing. One should always institute the above regi- 
men to prevent post-operative exacerbation. In gouty nephritis, a low protein diet 
and a more generous fluid intake are demanded in addition to other measures. Lith- 
ium salts greatly increase the solubility of urates in vitro but have been disappointing 
clinically. The pituitary adrenocorticotrophic hormone (10) has been shown to in- 
fluence uric acid excretion and probably both solubility and partition. It is able to 
hasten the control of the acute attack probably by substituting for the lag period in 
the thermostatic type, control of the pituitary gland for its release. The final result 
awaits more intensive clinical trial. A.C.T.H. can precipitate an attack if given in a 
remission period. Cortisone does not appear to be of as much value as the adrenals 
tend to become atrophic under this therapy. 

CONCLUSION 

The later in life the gout develops, the better the prognosis. It would appear that 
the disease only progresses rapidly in the individuals who do not enter wholeheartedly 
into a therapeutic regime. 

BIBLIOGRAPHY 

1. Pelletier & Caventou., Examen chimique de plusieurs vegetaux de la famille des colchicees 

et du principle actif qu' ils renferment, Ann Chim. Phys., 1820, XIV, 69. 

2. Talbott, J. H.. Serum Urate in Relatives of Gouty Patients, J. Clin. Invest: 1940, XIX, 645. 

3. See, G., Etudes Medicales sur l'acide salicylique et les salicylates, Bull. d. TAcad. d. Med.: 1877, 

VI, 689. 

4. Harkary, J., Allergic Factors in Gout, J.A.M.A., 139: 75, 1949. 

5. Robinson, W. D., Conn, J. W., Block, W. D., and Louis, L. H., Role of the Adrenal cortex 

in Urate Metabolism and in Gout, Proc. Central Soc. Clin. Research 21, 23, 1948. 

6. Aldersberg, D., Newer Advances in Gout, Bull. New York Acad. Med., 25, 651, 1949. 



132 BULLETIN OF THE SCHOOL OF MEDICINE. U. OF MD. 

7. Fitch, D., Personal Communication. 

8. Margoles, H. M., and Caplan. P. S., Treatment of Acute Gouty Arthritis, J. A.M. A. 142, 

256, 1950. 

9. Wilson, G., Personal Communication. 

10. Hench, P. S., Kendall, E. C, Slocumb, C. H., and Polley, H. F., Effects of Cortisone Acetate 
and Pituitary A.C.T.H. on Rheumatoid Arthritis, Rheumatic Fever and Certain Other Con- 
ditions. Arch. Int. Med. 85. 545. 1950. 



PERFORATION OF GASTROJEJUNAL ULCER FOLLOWING SUBTOTAL 
GASTRIC RESECTION FOR DUODENAL ULCER*f 

Case Report 

EMIL BLAIR, M.D. and OTTO C. BRANTIGAN, M.D. 

Baltimore, Maryland 

It is of unusual interest that the first report in the literature of a gastrojejunal 
ulcer was that of a perforated ulcer (14). As a complication following surgical treat- 
ment of peptic ulcers, gastrojejunal ulcers occur less frequently following subtotal 
gastric resection than after gastro-enterostomy alone. In the order of diminishing 
frequency, the site of perforation of anastomotic ulcers appears in the jejunum, at the 
anastomosis, and finally in the stomach (13). The greater majority of perforated 
ulcers open into the free peritoneal cavity, although a small number communicate 
with the bowel to form fistulas. Toland and Thompson (13), in a review of 103 case 
of perforated anastomotic ulcers, found that only six communicated with the bowel. 
These authors also found that most fistulas occur following gastro-enterostomy, 
whereas marginal ulcers follow subtotal gastric resection and are more likely to per- 
forate into the free peritoneal cavity (19). 

The following case is presented because, as far as is known, this is the first instance 
reported in which there was perforation at the site of the stomach in a gastrojejunal 
ulcer following subtotal gastric resection for duodenal ulcer. This perforation pene- 
trated into the free peritoneal cavity. 

Case Report 

B. C, a 47 year old negro male was admitted to the surgical service of the Baltimore City Hos- 
pitals on April 6, 1948, with a chief complaint of "pain in the stomach" of six months' duration. 
The symptomatology and clinical findings were fairly typical of duodenal ulcer. A roentgenologic 
examination revealed distortion of the duodenal cap caused by an ulcer and by spasm of the duo- 
denum and pylorus. Surgery was recommended because of the severe persistent pain, and a subtotal 
gastrectomy of the Polya type and an antecolic gastro-enterostomy were performed. The ulcer 
proper was removed by the resection. The patient withstood the procedure well; and following the 
customary progressive dietary regimen, he was discharged on the eleventh postoperative day. 

He was followed for seven months in the Out-Patient Department. During this time, he was 
entirely free of symptoms. Then he was not seen for a period of nine months, at the end of which 
he was admitted to the accident room, presenting signs indicating an acute surgical abdomen. Twelve 
hours previously, he had been seized suddenly with severe pain in the right upper quadrant. The 
distress soon spread over the entire abdomen. Two hours later, he noticed an aching pain in his left 
shoulder. On physical examination the blood pressure, pulse, and temperature were found to be 
normal. The positive findings were limited to the abdomen which had a boardlike rigidity and was 
generally tender. An upright roentgenogram of the abdomen revealed air under the diaphragm. 

The patient was taken immediately to the operating room where a laparotomy was performed. 
There was a moderate amount of free peritoneal fluid present, but only a small amount of contam- 
inant. A perforation 3 mm. in diameter was found in the stomach just above the site of the anas- 
tomosis. The perforation was closed with an invaginating suture of No. 00 chromic catgut and then 

* From the Department of Surgery, Baltimore City Hospitals, Baltimore. 
f Received for Publication, August 19, 1950. 

133 



134 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



reinforced with silk. An omental tag was sutured over the site of the perforation. The patient toler- 
ated the procedure well, and his postoperative course was uneventful. 

Inasmuch as the factors which had produced the ulcer were still present, further 
treatment was obviously indicated. To avoid a possible recurrence of this distressing 
complication, a trans-thoracic bilateral vagectomy was performed. Again the surgery 
was well tolerated. Repeated insulin-induced hypoglycemic gastric analyses revealed 
no free acid. The patient was asymptomatic during hospitalization. Roentgenographic 
studies revealed normally functioning anastomosis and no evidence of ulcer. The 
patient was discharged on the twenty-first postoperative day after the second oper- 
ation. A hypoglycemic study made four months later again revealed no free acid. 
The patient has hid no recurrence of symptoms to date, eight months after dis- 
missal. 




Fig. 1. This is an illustration of the site of the perforation in the stomach, just adjacent to the 
anastamosis. 

DISCUSSION 

It has been estimated that about 1 per cent of gastrojejunal ulcers perforate (13). 
In 1936 To land and Thompson (13) reported 93 instances of perforated anastomotic 
ulcers found in the literature. They added 10 of their own, making a total of 103. 
In 1938 Bracci (2) recorded 200 cases, and Warren and Fallis (15) reported 17 more 
in 1944. Ogilvie (8) added another in 1947, and in 1948 3 additional cases appeared 
in the literature (6, 9). Easton and Cole (3) reported 1 instance in 1949, as did 
Lurje (7). Although there are certainly more instances of perforated marginal ulcers 
than those reported, a search of the literature revealed only 239 cases including the 
case report discussed here. The greater majority of perforations occurred in ulcers 
following gastroenterostomy. This is to be expected because gastroenterostomy 
is more frequently complicated by anastomotic ulcer than subtotal gastrectomy. 

The conditions that produce duodenal ulcers will produce gastrojejunal ulcers; 
i.e., hyperacidity, hypersecretion, and hyperactivity. In addition, there are the 
factors of sensitivity of the jejunal mucosa, the role of infection, the presence of 
obstruction, and the finesse of surgical technic. The choice of doing an anterior or a 



BLAIR AND BRANTIGAN—GASTROJEJUNAL ULCER 135 

posterior anastomosis and the length of the loop may be contributing factors. The 
locale of the perforations would be in direct proportion to the most common locale 
of gastrojejunal ulcers. These occur most frequently on the efferent limb of the 
jejunal anastomosis and most rarely in the stomach. 

A perforated marginal ulcer presents an emergency problem. The quickest and 
simplest treatment is the best. In an instance where an adequate subtotal gastrec- 
tomy has been performed, the choice of a simple closure is obvious. In short, the 
treatment is similar to that prescribed for perforated duodenal ulcer. Where only a 
partial gastrectomy has been done, dismantling of the anastomosis and resection 
are advocated (7, 13, 15, 17). Uncomplicated gastrojejunal ulcers lend themselves 
to various methods of treatment (5, 7, 11). 

When the ulcer has been closed and the patient has recovered, there should be no 
delusion concerning the final end results. The distressing factors that produced the 
ulcer still persist, and further perforation can occur. The conditions threatening 
further ulceration must be eradicated. In this connection, the role of the vagus re- 
section is believed to be of great value. Vagotomy has even been advocated as the 
sole treatment of uncomplicated gastrojejunal ulcers (4, 18). The rationale, in its 
application for treatment of gastrojejunal ulcers, is identical to that applied to 
gastroduodenal ulcers. In the wake of experience with perforated ulcers, vagotomy 
is an essential and mandatory procedure. Thus, vagotomy serves not simply the 
beneficent role of a valuable adjunct, but assumes a major role in the prevention of 
recurrence of gastrojejunal ulcers. 

SUMMARY 

1. A case of a gastrojejunal ulcer perforating into the free peritoneal cavity 16 
months following subtotal gastrectomy is presented. 

2. Treatment consists of simple closure of the ulcer, followed by transthoracic 
vagectomy. 

3. A brief review of the literature concerning perforated gastrojejunal ulcers is 
presented. 

BIBLIOGRAPHY 

1. Benedict, E. B.: Jejunal ulcer. Surg., Gynec. and Obst, 56: 807, 1933. 

2. Bracci, U.: Perfazione in peritoneo libero di ulcera peptica insorta dope resezione. Arch. ed. 

Atti. d. Soc. Ital. di Chir., 44: 994, 1938. 

3. Easton, W. H. and Cole, W. H. : Precautions and results in gastrectomy. Arch. Surg., 59: 

768, 1949. 

4. Garxock, J. H. and Lyons, A. S.: The surgical therapy of duodenal ulcer. Surgery, 25: 352, 

1949. 

5. Jtjdd, E. S. and Horner, M. T.: Jejunal ulcer, Ann. Surg., Ill: 1003, 1935. 

6. Lowdon, A. F. R.: Gastrojejunal ulceration, Edinburgh Med. J., 55: 553, 1948. 

7. Lurje, A. : Treatment of perforated gastrojejunal ulcer by resection of stomach and anastomo- 

sis. Arch. Surg., 58: 281, 1949. 

8. OGiLvrE, H: Gastrectomy : A human experiment, Lancet, 2: 377, 1947. 

9. Plenk, A. and Zechman, A.: The surgical treatment of duodenal ulcer. Wien. Med. Wschr., 

98: 238, 1948. 
10. Prtestly, J. T. and Gibson, R. H.: Gastrojejunal ulcer: clinical features and late results. Arch. 
Surg., 56: 625, 1948. 



136 BULLET IX OF THE SCHOOL OF MEDICINE, U. OF MD. 

11. Ransom, H. K.: Treatment of jejunal ulcer, Arch. Surg., 58: 684, 1949. 

12. St. John, F. B., et. al.: Results following subtotal gastrectomy for duodenal and gastric ulcer. 

Ann. Surg., 128: 3, 1948. 

13. Toland, H. K. and Thompson, H. L.: Acute perforation of gastrojejunal ulcer. Ann. Surg., 

104: 827, 1936. 

14. Braun, W.: Quoted by Toland, T K. and Thompson, H. L.: Acute perforation of gastrojeju- 

nal ulcer. Ann. Surg., 104: 827, 1936. 

15. Warren, K. W. and Fallis, L. S.: Perforation of postoperative jejunal ulcers. Surgery, 15: 

569, 1944. 

16. Wilkie, J. P. D.: Jejunal ulcer. Ann. Surg., 99: 401, 1934. 

17. Rienhoff, W. F., Jr.: An analysis of the results of surgical treatment of 260 consecutive cases 

of chronic peptic ulcer of the duodenum. Ann. Surg., 121: 583, 1945. 

18. Trimble, I. R. and Lynn, D. H.: The surgical treatment of duodenal, gastric, and anastomotic 

ulcer, with especial reference to vagus resection. Surg., Gynec. and Obst., 90: 105, 1950. 

19. Klingenstein, P.: Gastrojejunocolic fistula. Surg. Clin. North America, 27: 315, 1947. 



CLINICO-PATHOLOGIC CONFERENCE 

From the Case Histories, University Hospital, Baltimore 

Clinical History 

A 49 year old white male was admitted to the surgical service of the University 
Hospital because of a spot on his lung. On April 17, 1950, he had a roentgenograph of 
his chest taken by a mobile x-ray unit and 6 weeks later was advised to have a larger 
film taken. He was told then that he had a "spot" on his lung, and hospitalization 
was advised. He denied having any chest pain, hemoptysis, cough, or night sweats. 
The patient smoked 2 or 3 cigars per day but had gained weight recently. He had 
been told that he had tachycardia and high blood pressure. There was no evidence of 
dyspnea, palpitation, and ankle edema. In 1927 he had had an attack of gonorrhea. 
The remainder of the past history was negative. 

His father died of appendicitis at the age of 58. His mother, 76 years old, was living 
and well. There was no family history of heart disease, tuberculosis, cancer, diabetes 
or asthma. 

The patient was a well developed, moderately obese, middle-aged, white male. 
There was no evidence of dyspnea, cyanosis, jaundice or edema. The pupils were 
round, equal, and central and reactive to light. Accommodation was normal. The 
trachea was in the midline, and there was no tug. The thyroid was of normal size. 
There was no cervical venous distention or lymphadenopathy. The axillary lymph 
nodes were not palpable. The lungs were clear to percussion and auscultation. The 
area of cardiac dullness was extended to the left anterior axillary line. The sounds 
were regular in rate and rhythm. There were no murmurs. The abdomen was obese. 
There were no palpable viscera, tendernesses, masses or spasm. 

Laboratory data included the following determinations: Blood hemoglobin con- 
centration was 110 per cent, (16.1 grams); hematocrit, 45 mm.; and blood urea nitro- 
gen, 14 mgm. per cent; blood sugar, 80 mgm. per hundred cubic centimeters of blood. 
A urine specimen was yellow and acid. Its specific gravity was 1.018. A trace of al- 
bumin was present. Two concentrated sputum smears stained for acid-fast organisms 
were negative. Roentgen studies of the chest were repeated (Fig. 1). 

On August 4, 1950, an exploratory thoracotomy was performed. Post-operatively, 
the patient's course was satisfactory; and on August 16, 1950, he was discharged 
from the hospital. 

Clinical Discussion 

Dr. William L. Garlick: We have the problem of a questionably healthy individual 
who has hypertension and a slightly enlarged heart and a shadow or spot in his lung. 
The word "spot" doesn't indicate "tumor" to me. In reviewing the statistics of mass 
roentgenographs, one finds that some 30 to 40 types of lesions have been discovered. 
On the basis of probability, one can make an almost exact diagnosis, since few symp- 
toms were presented by this patient. The least common of the lesions demonstrated 
by mass roentgenographic surveys are the neurologic tumors. A tumor arising in 
nerve usually would cause neuralgia. There is pain that encircles the body in the 

137 



138 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

instance of neuroma Such was not reported in this case. Bone disease should be 
considered. Pott's disease is not an uncommon condition, particularly in the 20 year 
old group. The radiologic defect lies usually behind the heart and sometimes in the 
mediastinum. Patients with this disease, however, do not feel well. They have symp- 
toms of chronic illness. This man obviously had no chronic disease. Chondromas, 
lymphomas, and plasmacytomas are seen occasionally in the ribs. I have had ex- 
perience with metastatic tumors of ribs which had been "silent" and which were 
found on ''plates" of the chest. I recall one rib tumor that turned out to be a metastasis 
from a hypernephroma. Another patient whom I saw had 20 to 30 small metastases 
in his left chest after pneumonectomy. He also had a hypernephroma. In both cases 
there were no symptoms referable to the kidney. Tumors of the breast, colon, and 




Fig. 1. Roentgenogram showing circumscribed area of increased density at periphery of right 
lung. 

oesophagus may metastasize to the chest before causing symptoms in the organ of 
origin. In classifying radio-opacities of the lungs and mediastinum, one must con- 
sider cardiovascular structures such as a dilated pulmonary conus, aneurysm, hyper- 
trophied left auricle, and pulmonary infarcts. In hemangiomas and arteriovenous 
aneurysms that occur in the lung, one usually finds a thrill over the anterior portions 
of the second to the fifth ribs. One might think of coarctation of the aorta, but this 
will usually give murmurs in the dorsum of the chest. An arteriovenous aneurysm 
in the lung field with a cystic cavity that is visible radiologically would cause a thrill 
or murmurs. 

The physical examination here states that no murmurs or thrills were heard. On 
routine roentgenograph ic films, a spot in the lower left or right chest close to the 



CLINICO-PATIIOLOGIC CONFERENCE 139 

heart border can be seen in patients who apparently are otherwise normal, but the 
history reports that the patient has been in an accident. Hernias in the chest should 
be thought of in such cases. In the anterior mediastinum, one might see a rounded 
shadow that is typical of a teratoma or dermoid cyst. These tend to occur in the 
mediastinum or near the pericardium. Occasionally, they will occur in the posterior 
mediastinum. Patients with dermoid cysts usually have a history of some vague 
complaint. For instance, we treated a woman who had a sensation of shifting weight 
in her chest every time she leaned over. She had been treated for neuroses, but roent- 
genographic studies revealed a large dermoid cyst. Because there was no lymphadenop- 
pathy, I assume that Hodgkin's disease may be dismissed. Thyroid, parathyroid, 
and pleural tumors are eliminated on the basis of their rarity and inconstant roent- 
genographic characteristics. One of the more common lung lesions is solitary or multi- 
ple cysts. These are usually discovered in younger people. They frequently have a 
history of repeated attacks of pneumonia and pneumonitis, or else history of spon- 
taneous pneumothorax is obtained. An emphysematous bleb or cystic cavity may be 
seen in a roentgenograph. About 1 in 800 persons in a mass roentgenographic series 
have congenital cystic lesions, but cysts of this type constitute the third largest 
group of tumors that are discovered. 

I think we can rule out most inflammatory lesions in this patient, because he did 
not have a feeling of morbidity. Too, these inflammatory lesions are very easily 
diagnosed by roentgenography. The most commonly encountered pulmonary disease, 
(and the incidence is 1 out of 60 people) is tuberculosis. Its type may be a healed 
tuberculosis, a Ghon tubercle, an early acute active tuberculosis, or a reactivation 
of an old lesion. I think we can rule out bronchiectasis because this man did not have 
cough or hemoptysis. The second most common group of lesions, particularly if they 
are circumscribed, is primary bronchogenic carcinoma. The next most common 
lesion in such a patient would be adenoma. In bronchoscopic clinics, we frequently 
see adenomas that cause atelectasis and thereby throw a shadow. I want to emphasize 
that every circumscribed lesion in the lung should be considered as carcinoma until 
proven otherwise. I would pick as the first diagnosis on this patient a Ghon tubercle 
or tuberculoma, because this is the most common lung tumor that causes a roent- 
genographic shadow. The diagnosis that I would choose secondly is bronchogenic 
carcinoma, and lastly, bronchogenic cyst. 

Dr. D. J. Bamett: We called this lesion a tuberculoma. The lesion is about 1| cm. 
in diameter, peripheral in the lung, and solitary. In the solitary lesion there are 
plaques of calcification which are more dense at the center of the lesion than in the 
periphery. The heart is slightly enlarged. 

Senior Student: Is there a relationship between tuberculoma and malignancy? 

Dr. D. J . Bamett: No. However, I have seen carcinomas arising in tuberculomas. 
They usually arise in the periphery of the tuberculoma. 

Dr. H. R. Spencer: I do not know of any definite relationship that might exist be- 
tween the two. As Dr. Garlick has suggested, any inflammatory lesion or destructive 
process of the lung may instigate squamous metaplasia which might be a site for the 
development of squamous carcinoma. Some years ago I saw a man who gave a his- 
tory of tonsillectomy and subsequent pain in his chest. Three years later, a lung 



140 BULLET IX OF THE SCHOOL OF MEDICINE, U. OF MD. 

lesion was found. It was thought that following the tonsillectomy he had an infected 
embolus with infarction and lung abscess. At autopsy, he was found to have a car- 
cinoma in the periphery of his lung, which had had its origin in the squamous lining 
of an old cavity. 

Senior Student: Did subsequent films in this case show that this lesion had grown 
any? 

Dr. Barnett: I can't answer that. This is the only film we have. The films made 
elsewhere are not available to us. 

Dr. R. C. Sheppard: One doesn't wait for tumors to increase in size. Take them 
out and look at them. 

Dr. R. M. Cunningham: Calcium in a peripheral lesion probably indicates a life- 
long duration of the lesion. If one doesn't see any indication of calcification, remove 
the lesion. In such a case, carcinoma cannot be ruled out by clinical procedures. 
There has never been a carcinoma reported that had calcium in it. 

Dr. Spencer: I would like to ask Dr. Garlick to comment on that point. 

Dr. Garlick: My feeling is exactly that. With the assistance of films, one ought 
to be able to show calcareous matter in most of these lesions. On the basis of one 
film or a series taken in a short time, I see no reason to remove the tumor surgically. 
If surgical treatment is needed to make a diagnosis, a segmental resection of the 
lung should be performed. If the tumor should be carcinoma of the lung, a lobectomy 
may cure the carcinoma as readily as a pneumonectomy. 

Pathologic Discussion 

The gross specimen, S.P. # 69662, in this case consisted of a small piece of lung 
tissue which contained a round, well circumscribed encapsulated lesion that was ap- 
proximately 2.5 cm. in diameter. The lesion consisted of a laminated caseous mass 
which presented the characteristics of tuberculosis. Histologic sections showed casea- 
tion surrounded by fibrous tissue. There was no evidence of recent activity. 

Anatomic Diagnosis 
Tuberculoma. 



OBSTETRICAL CASE REPORT* 

Mrs. R. E. was admitted to the hospital on May 23, 1950, in active labor and with the following 
significant history. She had had 4 previous full term pregnancies and normal labors. All 
of the babies lived and were healthy. There were no other pregnancies. Her present pregnancy was 
characterized by more than the usual amount of abdominal pain, probably on the basis of muscle 
relaxation. The estimated date of confinement was May 30. On the morning of the day of admission 
the membranes ruptured spontaneously; and after a latent period of 4 hours, labor began. The 
patient reached the hospital about 6 hours after rupture of the membranes. Abdominal palpation 
at this time revealed a transverse presentation, the diagnosis being R.Ac. A. The fetal heart was 
easily heard near the umbilicus; the rate was 140 and the sounds regular. A rectal examination was 
most interesting in that the cervical canal was only about one half effaced and the external os about 
3 cms. dilated. There was a loop of umbilical cord protruding through the cervix, but still within 
the vagina. The pulsations in the cord were synchronous with those of the fetal heart. The estimated 
size of the fetus was 3400 grs (7| lbs.). Her pains were 4 to 6 minutes apart and moderately severe. 
The mother's condition was entirety normal. 

Discussion: Thinking about the treatment of a transverse presentation has changed 
considerably in recent years, especially since antibiotics have made abdominal de- 
livery so much safer. For years the dangers of internal podalic version and breech 
extraction were recognized; but in the treatment of certain cases of transverse lie, 
it appeared to be the lesser of two evils. Most physicians could not bring themselves 
to do a decapitation or another destructive operation on a living healthy baby and 
deliberately accepted the increased risk to the mother which accompanied version 
and extraction. All too frequently the results were bad. Fortunately, modern methods 
of combatting infection permit the use of the abdominal route today under circum- 
stances which would almost certainly have been fatal a few years ago. And the case 
cited above is one in point. Abdominal delivery should be quite safe for this mother 
and offers the best possible chance for the baby. 

Since this is her fifth term pregnancy, and if cesarean section is to be per- 
formed it will be undoubtedly more satisfactory for the patient if she does not con- 
ceive again. Sterilization should be considered. 

Actual treatment: Cesarean section and sterilization were performed. The patient 
had a normal convalescence, both mother and child being discharged in good con- 
dition. 

* From the Department of Obstetrics, University of Maryland School of Medicine, Baltimore. 



141 



BOOK REVIEW 

Methods in Medicine, 2nd Edition, 1950 (1st, 1924) George R. Herrmann, M.D., Ph.D., C. V. Mosby 

Company, St. Louis 

This book is a re-issue of The Manual of the Medical Service of Dr. George Dock published in 
1924. It is apparently designed for the guidance of the intern in working up his cases and of the 
clinical student in observing the way those patients are studied. 

History taking and physical examinations are given a brief outline. Techniques and procedures 
are briefly described for routine hematologic studies, urinalysis, examination of sputum, gastric 
contents, spinal an paracentesis fluids, staining of bacteria, blood chemistry determination, and a 
few other clinical tests. The brevity maintained in this 132 page section limits its interest to the 
medical student and intern. They could be expected to have classroom notes outlining all the methods 
described in this text. 

To special studies in suspected infectious disease cases six pages are devoted. The specific tests 
described in two or three paragraphs include the tuberculin test, the Kveim reaction (sarcoidosis) 
the Schick, Dick, and brucellergin tests. A few other studies are mentioned. 

Other chapters on various classes of disorders present special features of the history, physical 
examination, and laboratory studies which are to be remembered and performed. These classes 
include endocrine, metabolic, nutritional, allergic, pulmonary, cardiac, and the other systemic dis- 
orders. Clinical pathologic testing comprises the bulk of material in this section. 

The book ends with some general therapeutic procedures and practical dietetic methods for the 
management of various conditions. 

For the intern or practitioner who has limited time for brushing up on a large number of specific 
laboratory tests, this book can have definite value. 

Joseph H. Bird, M.D. 



142 



MEDICAL SCHOOL SECTION 
DEPARTMENT OF PSYCHIATRY 

Aided by a grant from the Bressler Research Fund of the School of Medicine, the 
Department of Psychiatry has been engaged in a project relating to the study of 
psychiatric education. The success experienced in the early stages of the project has 
resulted in a decision to broaden the study into other fields of medical education. 

The Department of Psychiatry plans to conduct a series of seminars led by com- 
petent workers in the field of general education and medical education to discuss and 
perhaps formulate the best available information as to the theories and practice of 
medical school teaching. 

The first seminar was held on April 16 at which time Dr. John R. Reid, Professor 
of Philosophy at Stanford University, California, who is currently visiting Professor 
of Psychiatry, initiated the seminar with a talk on "Human Values in Medical Edu- 
cation." 

The Department of Psychiatry will distribute copies of the Proceedings of these 
seminars throughout the school year. 

PROGRESS NOTE III 




View of construction of new Psychiatric Building as of May 11, 1951 



ii BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

APPOINTED ASSISTANT PROFESSOR OF PHYSIOLOGY 

The Department of Physiology has announced the appointment of Dr. John 
McCullough Turner as Assistant Professor of Physiology, effective in August, 1950. 

Dr. Turner was born in New York City on March 5, 1908, receiving his under- 
graduate college training at Yale University and graduating in 1931. From 1932-33 
he traveled extensively on the Continent and in 1934 entered the pre-medical de- 
partment of Columbia University- In 1935 he entered the Cornell University School 
of Medicine, transferring to the Yale University Graduate School at the end of the 
second year. While at Yale, he was associated with Dr. Howard W. Haggard in the 
department of Applied Physiology, receiving his Doctor of Philosophy degree in 1943 
on the subject of "The Oxidation and Elimination of Exogenous Acetone." From 
1942-45 he served as a Lieutenant in the United States Navy, conducting research 
relating to physiologic problems associated with certain internal combustion en- 
gines and certain noxious gases in closed ships' spaces. From 1946-49 he was Asso- 
ciate Professor in the Department of Applied Physiology at Yale University, fol- 
lowing which he served a year as Assistant Professor of Pharmacology and Physiology 
at the University of Connecticut College of Pharmacy. 

Dr. Turner is married and has two children. 




Dr John McCullough Turner. 



MEDICAL SCHOOL SECTION iii 

FACULTY-STUDENT COUNCIL DINNER 

Members of the Faculty and Student Council gathered on May 10th for the annual 
Faculty-Student Council dinner. 

This meeting, inaugurated almost 10 years ago and highly popular with the Student 
Government, Administration, and Department Heads, provides a common meeting 
ground for the exchange of constructive ideas to further student-faculty relations 
and to discuss informally at dinner, problems arising in the student body which 
perhaps would not otherwise be brought to faculty attention. 

This year discussion centered principally about certain curriculum changes, the 
possible introduction of the honor system for student examinations, and for a closer 
faculty-student association. 

A student plan for the elimination of grade consciousness was also presented for 
faculty consideration. Presentations by class Presidents and the President of the 
Student Council, Mr. William Matthews, were most constructive and entertained 
considerable discussion from most of the faculty present. 




Members of Student Government and Department Heads are shown at the annual Faculty-Student 

Council dinner on May 10th 



MEDICAL LIBRARY NOTES 

Gifts continue to come to the library from generous alumni and other friends. 
Between February 1 and May 1, the following donors presented material to the 
library : 



iv BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

Dr. Margaret B. Ballard Dr. Page C. Jett 
Dr. H. K. Fleck Dr. Arthur M. Kraut 

Dr. Frank W. Hachtel Mr. Morton Krieger 

Mr. W. L. Holder Dr. H. B. McDonnell 

Dr. H. Boyd Wylie 

The Medical Library is benefited greatly from the revised and expanded exchange 
list of the BULLETIN OF THE SCHOOL OF MEDICINE. Many significant new 
periodical titles are being added to the library collection on an exchange basis. There 
has been a good response from both foreign and domestic journals interested in 
receiving the BULLETIN and providing the Medical Library with their publications. 

The annual meeting of the Medical Library Association was held in Denver, 
Colorado, at the end of June this year. Librarians in all divisions of the health 
sciences attended this meeting, not only from every corner of the United States, but 
from foreign countries as well. Each year the Schools of Medicine, Dentistry, and 
Pharmacy of the University of Maryland have made it possible for their librarians 
to attend the meeting and represent the libraries. This year, the librarian, Mrs. 
Ida M. Robinson and the assistant librarian, Miss Hilda Moore, attended this 
meeting. 

MERCY HOSPITAL 

New Medical Statistician 

On April 16, Mr. L. Omer Huesman came to Mercy Hospital as Statistician in 
charge of the Statistical Department. A graduate of Calvert Hall High School, 
class of 1926, Mr. Huesman has been active in the field of medical statistics and for 
the past 14 years has been Supervisor of the Statistical Department at the Johns 
Hopkins Hospital. 

Armed Forces Section 

Dr. Joseph C. Sheehan, class of 1941, of the Obstetrical Visiting staff of Mercy 
Hospital, left March 15, 1951, for service as a Captain in the United States Army, 
at Fort George G. Meade, Maryland. 

WOMEN'S AUXILIARY OF MERCY HOSPITAL ORGANIZED 

On February 28, 1951, the first general meeting of the Women's Auxiliary of 
Mercy Hospital was held at the hospital. Sister Mary Veronica, R.S.M., Adminis- 
trator, addressed the members and stressed the necessity of a Women's Auxiliary to 
help raise funds and act as volunteer workers in the hospital. 

Meetings will be held on the fourth Wednesday of each month at 11 A.M. in 
Room 33 of the hospital. Sister Mary Frances Louise, R.S.M., will serve as moderator 
of the group. 

Mrs. Charles R. Goldsborough has been elected Chairman of a benefit which will 
be held in the fall of 1951 at the Alcazar. 



MEDICAL SCHOOL SECTION v 

DEPARTMENT OF MEDICINE 

Department of Clinical Pathology 

Dr. Milton S. Sacks, Director of the Department, spoke on "The Biochemical 
Defect in Pernicious Anemia: A Review of Recent Work with Comments on Oral 
Therapy," at the Sinai Hospital, Baltimore, staff meeting on April 26, 1951. A 
series of lectures entitled "Blood Groups and Blood Transfusions" were given by 
Dr. Sacks at the Veterans' Hospital, Fort Howard, Maryland, during May and 
June, 1951. Dr. Sacks has also contributed the section on "The Treatment of Ery- 
throblastosis Fetalis" in the 1952 edition of Current Therapy, edited by Dr. Howard 
F. Conn. An editorial written by Dr. Sacks entitled "Ion Exchange Resins" appeared 
in the Annals of Internal Medicine in April, 1951. 

Dr. Joseph Workman, Baltimore Rh Typing Laboratory Fellow in Medicine, 
recently read a paper entitled "The Lupus Erythematosis Cell Phenomenon" at the 
meeting of the Dermatology Section of the Baltimore City Medical Society. 

Dr. Marie Andersch, Chief Biochemist of the Department of Clinical Pathology, 
attended the Federation meetings in Cleveland, Ohio, on April 29, 1951, where she 
read a paper entitled "Studies in Alkali Denaturation of Hemoglobin." 

DEPARTMENT OF SURGERY 

The Department of Surgery is fortunate in being able to extend its clinical teaching 
programs so that Baltimore City, Mercy, Kernan, and University Hospitals are 
intimately involved in the subdepartments of Orthopedics, Genito-Urinary and 
Neurosurgery. Certification by the respective boards covering training in these 
departments has been obtained. 



Dr. Russell S. Fisher, Associate Professor of Legal Medicine at the School of 
Medicine and Chief Medical Examiner of Maryland, has recently been awarded a 
United States Public Health Service Grant for research in unexpected death in 
infancy and for continued study of the human cervix for carcinoma. 

UNIVERSITY OF MARYLAND BIOLOGICAL SOCIETY 

At the Program Meeting held on March 14, 1951, Dr. Gordon E. Gibbs, Associate 
professor of Clinical Research of the Department of Pediatrics, presented a paper 
entitled "The Effect of Pressure within the Pancreatic Ducts upon Pancreatic 
Histology and Serum Amylase", an abstract of which follows. 

The Effect of Pressure Within the Pancreatic Ducts Upon Pancreatic 
Histology and Serum Amylase 

Ligation of all pancreatic ducts in 3 dogs was followed during 24 hours by a gradual rise in serum 
amylase to a value 2.8 times the initial level. Edema and slight leukocytic infiltration of the capsule 
and interlobular septa of the pancreas were present at the end of this period. In 5 other dogs, the pan- 
creas was subjected to a pressure of 30 cm. water within the duct system by means of a reservoir of 
sterile saline. Serum amylase rose approximately twice as fast, and most dogs failed to survive the 



vi BULLETIN OF THE SCHOOL OF MEDICI XE, U. OF MD. 

full 24 hours. The pancreatic changes were edema, a greater degree of inflammatory reaction (in- 
cluding acinar areas), slight hemorrhage, and small areas of acinar cell degeneration. Some fluid rich 
in enzymes filtered through the surface of the pancreas and collected in the peritoneal cavity. That 
this fluid probably accounted for part of the amylase that appeared in the serum was indicated by the 
fact that a rise of serum amylase followed injection of pancreatic juice intraperitoneally in two other 
dogs. One of these had been depancreatized and maintained with insulin. The other showed no histo- 
logic evidence of damage to the pancreas. 



POST GRADUATE COMMITTEE SECTION 
POST GRADUATE COMMITTEE, SCHOOL OF MEDICINE 



Howard M. Bubert, M.D., Chairman and Director 
Elizabeth Carroll, 
Executive Secretary 

Post Graduate Office: Room 600 
29 South Greene Street 
Baltimore 1, Maryland 



Extramural Courses 

The demand for post graduate instruction has grown at an ever increasing tempo. 
Two major factors have contributed to this: first, an aroused interest and desire 
upon the part of many physicians for such instruction and, secondly, the dramatic 
discoveries of the recent past that have rendered obsolete many of the therapeutic 
and diagnostic mainstays of previous years. 

Superficial consideration might seem to indicate that the problem of satisfying 
these needs was a relatively simple one, but this, for various reasons, is far from true. 
Chief among these are the apathy exhibited by many of those men most in need of 
instruction and the crushing burden of work borne by most busy physicians. 

In an effort to overcome the obstacles encountered, the Committee has endeavored 
with, we believe, some measure of success to evolve new techniques. Not the least 
of these has been the establishment of extramural courses in which the teaching is 
done at points selected because of their proximity to the participating physicians' 
zone of operations. It seemed better to take the few to the many rather than the 
many to the few. 

Certain of the county medical societies have acted as sponsors for these programs 
and have made all local arrangements while the Post Graduate Committee has as- 
sumed responsibility for providing competent instructors. 

Those men interested in taking part in this activity might well communicate with 
the president or secretary of their society or directly with the Post Graduate Com- 
mittee Office. If sufficient interest is evidenced in a given area, such a course could 
be arranged with little difficulty. 

It is our ardent wish that this important phase of our work will grow and that 
extramural courses will become an established custom in an increasing number of 
counties throughout the state. 

Pediatric Residency 

Decentralization of pediatric graduate training has been carried on successfully 
in many parts of the country. In September, 1948, the Pediatric Department of the 
University of Maryland Hospital began a resident affiliation plan with the Penin- 
sula General Hospital in Salisbury, Maryland. Initially, the period of rotation was 



viii BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

three months, but it has now been extended to four. Assistant residents who have 
had some training in pediatrics, when assigned to Peninsula General Hospital, act 
in the capacity of resident, supervising the care of patients admitted to the pediatric 
service as well as providing supervision for the well baby nursery. In addition to their 
hospital duties, they conduct the well baby and pre-school clinics for the Maryland 
State Department of Health and work with some of the other local civic organiza- 
tions who are interested in child health. 

Immediate hospital supervision is provided by the local pediatrician in charge of 
the service while periodic visits are made at six-week intervals by a staff member of 
the Pediatric Department of the University Hospital. In the experience of the Pedi- 
atric Department with this type of program, it has been concluded that it is of con- 
siderable value to the participating assistant resident, primarily, in that he becomes 
familiar with pediatric practice in a smaller community. Also, he is faced with re- 
sponsibility and forced to make use of his diagnostic training, thus, discouraging 
dependency upon expensive and often needless laboratory measures. Experience with 
the local health units is a broadening one in that it has tended to provide men in 
training with a knowledge of the relationship of the practicing pediatrician to the 
local health effort. 

The advantages of the program are not, however, all on the side of the University. 
The value of the local hospital is increased in the eyes of the community by its asso- 
ciation with a medical center. At the same time, the presence of residents acts as an 
educational stimulus for the local physicians, and the community is made more at- 
tractive to pediatricians who are contemplating practicing in that area. 

When the affiliation was begun, there was only one pediatrician in the community 
eligible to take the Pediatric Board examination. There are now three pediatricians 
practicing in the community — one having been certified and the other two, eligible 
to take the examination. Affiliations of this type should be utilized as a vital part of 
the post graduate instruction. They offer opportunities of on-the-spot instruction for 
local physicians and, through this means, it is possible for us to offer broader vistas 
of pediatric knowledge to the practicing physicians of the community with resulting, 
improved pediatric care for the patients. 

It is the hope of the Pediatric Department of the University of Maryland School 
of Medicine that this affiliation will be continued, strengthened, and enlarged and 
that similar affiliations eventually can be carried out with other hospitals in the 
State of Maryland. 

Thoracic Surgery Residency 

The Post Graduate Committee is happy to announce that Dr. Otto C. Brantigan 
has succeeded in initiating a plan for the training of thoracic surgeons. The first year 
of resident training is spent at the University of Maryland in research, and the second 
year, as thoracic surgeon at University, Mercy, and City Hospitals. Upon comple- 
tion of these two years, he will then be eligible for examination by the American 
Board of Surgery and The American Board of Thoracic Surgery. We take pride in 
the completion of another step forward in this field. 



POST GRADUATE COMMITTEE SECTION ix 

Orthopedic Residency 

It is with great pleasure that the Post Graduate Committee calls attention to the 
approval of the three-year resident training service program in orthopedic surgery, 
described in previous issues of the BULLETIN, by the American Medical Asso- 
ciation. 

Maryland Academy of General Practice 

Because of the interest evidenced by members of the Maryland Academy of Gen- 
eral Practice in the seminar sponsored by their society in December, 1950, Dr. 
Lauriston L. Keown, in cooperation with the Post Graduate Committee, arranged 
a similar day of lectures which were presented on May 24, 1951. The following pro- 
gram was presented, the material of which, we believe, is varied and timely. These 
sessions were held in the Gordon Wilson Amphitheater of the University Hospital. 



10:00-10:50 Chest Diseases 

11:00-11:50 Melena 

12:00-12:50 Acute Nephritis 

1:00- 1:50 Cardiac Emergencies 



1:50- 2:50 Luncheon 

3:00- 3:35 ACTH and Cortisone in Re- 

lation to Arthritis and 
Allied Conditions 

3:40-4:15 ACTH and Cortisone in Re- 

lation to Acute Rheu- 
matic Fever 

4 : 1 5- 4 : 50 ACTH and Cortisone in Re- 

lation to Allergic Condi- 
tions 



Otto C. Brantigan, B.S., M.D. Professor 
of Surgical Anatomy, Professor of Clin- 
ical Surgery, University of Maryland 

Harry C. Hull, M.D., Professor of Clinical 
Surgery, University of Maryland 

Milton S. Sacks, M.D., Head of Clinical 
Pathology, Associate in Pathology, As- 
sociate Prof, of Medicine, University of 
Maryland 

William S. Love, Jr., A.B., M.D., Asso- 
ciate Prof, of Medicine, University of 
Maryland 

T. Nelson Carey, M.D., Professor of Clin- 
ical Medicine, University of Maryland 

J. Edmund Bradley, M.D., Professor of 
Pediatrics, Head of Dept. of Pediatrics, 
University of Maryland 

Howard M. Bubert, M.D., Associate 
Prof, of Medicine, Chief, Section of Al- 
lergy, University of Maryland 



Members of the Maryland Academy of General Practice were guests of the Post 
Graduate Committee at a luncheon served in the Hospital dining room at which 
Dr. H. Boyd Wylie, Dean of the University of Maryland School of Medicine, greeted 
those present. 

In December, 1950, 64 physicians attended these lectures, representing the fol- 
lowing counties in Maryland: Allegany, Baltimore, Caroline, Carroll, Frederick, 
Garrett, Harford, Prince Georges, Talbot, Washington, and Worcester. 

Officers of the Maryland Academy of General Practice are: Dr. Charles F. O'Don- 
nell, Towson, Maryland, president; Dr. Irving Baumgartner, Oakland, Maryland, 
secretary-treasurer; and Drs. E. Paul Knotts, Nathan Needle, and B. B. Kneisley, 
vice-presidents. 






ALUMNI ASSOCIATION SECTION 



OFFICERS 
Lours A. M. Krause, M.D., President 
Vice-Presidents 
Samuel E. Enfield, M.D. Randolph M. Nock. M.D. 

Thurston R. Adams, M.D., Secretary Simon B 

Minette E. Scott, Executive Secretary Charles 

Board of Directors Hospital Council 

William H. Triplett, M.D. Alfred T. Gundry, M.D. 



Chairman 

Louis A. M. Krause, M.D. 
Charles Reid Edwards, M.D. 
Thurston R. Adams, M.D. 
Simon Brager, M.D. 
Austin Wood, M.D. 
Wetherbee Fort, M.D. 
Albert E. Goldstein, M.D. 
Daniel J. Pessagno, M.D. 



Louis H. Douglass, M.D. 



George F. Sargent, M.D. 
Nominating Committee 
Frank Ogden, M.D. 

Chairman 
Robert F. Healy, M.D. 
Ernest I. Cornbrooks, M.D. 
Frank K. Morris, M.D. 
David Tenner, M.D. 



Alumni Council 



Fred B. Smith, M.D. 
rager, M.D., Assistant Secretary 
Reid Edwards, M.D., Treasurer 

Library Committee 
Milton S. Sacks, M.D. 
Representatives to General Alumni 

Board 
John A. Wagner, M.D. 
Thurston R. Adams, M.D. 
William H. Triplett, M.D. 
Representatives, Editorial Board, 

Bulletin 
Harry C. Hull, M.D. 
Albert E. Goldstein, M.D. 
Louis A. M. Krause, M.D. 

(ex-officio) 
Lewis P. Gundry, M.D. 



The names listed above are officers for the term beginning July 1, 1950 and ending June 30, 1951. 



A LETTER TO THE CLASS OF 1951 

FROM THE MEDICAL ALUMNI ASSOCIATION 

The diploma which now hangs on your wall is certainly an acknowledgment of a 
long cherished ambition and a recognition of your perseverance and ability as wit- 
nessed by the Faculty of Medicine which has seen fit to bestow it upon you. You 
are no doubt quite proud in your new office and most certainly do you covet the 
enviable, professional status which has been your just reward. 

We, of the Alumni Association, do congratulate you upon your achievement and 
extend a welcoming hand of friendship as you become one of the several thousand 
living alumni of the School of Medicine. Your days as an undergraduate medical 
student are now at an end. As a physician and an alumnus, you have entered the 
second sphere of the practice of medicine and upon your shoulders now rest obliga- 
tions which far exceed those which you have considered heretofore as being weighty. 
You will have obligations to family, to your patients, and to the community in 
which you reside; for indeed, the profession which is yours to enjoy is an honorable 
one and must be defended by what you know as ethics, by community leadership 
and by exemplary behavior. In the Hippocratic Oath to which you have now sub- 
scribed, there is an explicit statement concerning your obligation to enlarge and 
perpetuate the medical training of those who would follow in your footsteps. The 
implementation of this, your subscribed promise, no doubt at this moment seems 
vague. No doubt you consider it wise to maintain an active interest in medical 
education, for as a student you have at times voiced both criticism and praise of 
educational methods as they applied to you. You were perhaps impressed and 



ALUM XI ASSOCIATION SECTION xi 

sometimes depressed at the physical surroundings; the adequacy or inadequacy they 
presented in the furtherance of your educational desires. These physical surroundings 
and their facilities resulted from the work and attention of men who were your 
predecessors in medicine. As you now become an alumnus, the continuation of such 
facilities and their improvement becomes an increasing part of your obligation. 

At Commencement, the class of 1951, as a unit, became dismembered. You will 
no longer attend classes together, and there will be no more class dances. However, 
the unity of your class is now maintained through the unity of your Alumni Asso- 
ciation. What advances you as an individual can make in the perpetuation of the 
good name of your Alma Mater rests not alone in your personal achievements but 
through your activities in the Alumni Association whose sole purpose is the advance- 
ment and the guardianship of the traditions of the school from which you have 
drawn so bountifully. The Alumni Association is not a social group nor is it a political 
venture. It is not a subsidiary of the faculty nor a branch of the Dean's office. It is 
an autonomous organization of all alumni through which their interest and activities 
can be focused toward a common goal: a better school of medicine. 

Your Alumni Association has voted you a free membership for the year 1951-52 
and at the same time has purchased for you a subscription to the official Alumni- 
Faculty journal, the Bulletin. We feel that our desire to have you as an interested 
alumnus and to have you grow into the Association is expressed not only by our 
overt gestures but by an abiding faith in your interest to the effect that it shall 
continue unbroken through the many years that lie ahead. 

Congratulations to you all. 

William D. Triplett, M.D. 
Chairman, Board of Directors 

Correction 



In the Bulletin (36: Alumni Section, p. xxi, January, 1951) it was stated 
that Dr. Wilbur S. Brooks, class of 1938, was Chief Radiologist at the Univer- 
sity of Syracuse, Syracuse, New York. Dr. Brooks is attending radiologist at the 
General Hospital of Syracuse. 

The Bulletin sincerely regrets the error. 



ITEMS 

Dr. Hiram P. Upton, class of 1927, of Burlington, Vermont, has been appointed a 
member of the Vermont State Health Commission. Dr. Upton has recently served 
as president of the Vermont State Medical Society. 

Dr. Charles A. Neafie, class of 1909, of Pontiac, Michigan, was recently elected a 
founder member of the American Board of Preventive Medicine and Public Health. 
He has been identified with public health administration in Pontiac since 1917, re- 
ceiving the degree of Master of Science in Public Health from the University of 
Michigan in 1924. 

Dr. Otto C. Brantigan presented a paper entitled "Thoracoplasty in the Treat- 
ment of Pulmonary Tuberculosis" at the April, 1951 meeting of the Southeastern 
Surgical Conference. 



xii BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

Dr. John C. Ozazewski, class of 1943, and until recently Resident in Ophthal- 
mology at the University Hospital, will be associated with Dr. Frank Walsh in the 
practice of Neuro-ophthalmology. 

Dr. George W. Smith of the Department of Neurosurgery has recently been elected 
a member of the American Association of Electroencephalographers. 

Dr. John H. Shaw, class of 1947, until recently Resident in Medicine at the St. 
Agnes Hospital, Baltimore, has recently opened his office for the practice of Internal 
Medicine at 701 Charing Cross Road, Baltimore. 

Dr. Arthur T. Hall, class of 1945, who completed his Residency in Surgery at the 
St. Agnes Hospital in Baltimore on July 1st, has opened his office at 7 East Mt. 
Royal Avenue in Baltimore where he will begin practice of General Surgery. 

Dr. Robert M. N. Crosby, class of 1943, who completed his Residency in Neuro- 
surgery at the School of Medicine on July 1, 1951, has been appointed to the Faculty 
of the University of Chicago School of Medicine. Dr. Crosby will devote his practice 
to Pediatric Neurology under the preceptorship of Dr. Douglass Buchanan. 

With the completion of his Residency year in Obstetrics on June 30, 1951, Dr. 
William C. Covey, Jr. plans to enter private practice in his home town of Beckley, 
West Virginia. 

Dr. Frank J. Ayd, Jr., class of 1945, recently lectured at the 19th Annual Con- 
vention of the National Conference on Family Life which was held in St. Louis, 
March 5-7, 1951. Dr. Ayd is currently on the faculty of the Catholic University in 
Washington and is a member of the Department of Psychology at Loyola College 
in Baltimore. 

Dr. Frank J. Ayd, Jr., class of 1945, was guest lecturer at the University of Notre 
Dame, South Bend, Indiana, on April 26, 1951, at a meeting held under the joint 
auspices of the Department of Religion and the General Program of Liberal Edu- 
cation. Dr. Ayd spoke on the subject of "Religion and Psychiatry." 

Dr. William E. McGrath, class of 1943, who was called to active duty in the 
United States Army in October, 1950, has been separated from the armed forces and 
has returned to his practice at 3534 Edmondson Avenue, Baltimore. 

Dr. Louis O. J. Manganiello, class of 1942, a former resident in Neurologic Surgery 
at the University Hospital, has been appointed Chief of the Department of Neuro- 
logic Surgery at the University of Georgia School of Medicine, Augusta, Georgia. 

Dr. Robert A. Moses, class of 1942, has recently opened his offices at 110^ South 
Third Street, Delevan, Wisconsin. Dr. Moses will limit his practice to ophthalmology. 

Dr. J. Morris Reese, class of 1920, Associate Professor of Obstetrics, has been 
appointed Councilor of the Southern Medical Association for a five year period begin- 
ning in the Fall of 1951. Dr. Reese will succeed Dr. F. A. Holden, also of the class of 
1920, who has served for a number of years on the Council of the Southern Medical 
Association. 

Dr. Frank Concilus, class of 1942, for the past two years has resided at 470 Summit 
Drive in Pittsburgh where he^has been engaged in the practice of Internal Medicine. 






ALUMNI ASSOCIATION SECTION xiii 

Dr. Edward Siegel, class of 1938, has served as co-author with Dr. Conrad Berens, 
of a new textbook entitled Encyclopedia of the Eye. 

Dr. Siegel currently practices ophthalmology in Plattsburg, New York. 

Dr. Melvin B. Davis, class of 1931, was recently elected President of the Baltimore 
County Medical Society. 

Dr. Thomas P. Murdock of Meriden, Connecticut who is currently serving as a 
member of the Board of Trustees of the American Medical Association was honored 
at a testimonial dinner at New Haven, Connecticut on November 29, 1950. Dr. Mur- 
dock is a graduate of the Baltimore Medical College, class of 1910. 

Dr. Fred R. McCrumb, class of 1948, has been appointed Fellow in Medicine at 
Rockefeller Institute in New York where he will continue his studies in infectious 
diseases. 

The Mayo Clinic announces the following appointments from the Class of 1950: 

Dr. Louis G. Chelton, has been appointed Fellow in Medicine, Dr. John L. Bacon, 
Fellow in Pediatrics and Dr. Stanley W. Henson, Jr., Fellow in Surgery effective 
July 1, 1951. 

These three Alumni are currently serving their internships at the United States 
Marine Hospital in Baltimore before proceeding to the Mayo Clinic. 

CORRESPONDEN CE 

December 11, 1950. 

Thanks very much for your interesting letter of November 20, giving me Dr. 
Rowland's address and giving me data, etc. about the Reunion, June 7th, 1951. 

Just celebrated my 77th birthday and am looking forward to being present and 
receiving my 50 year certificate. I will try to get Dr. H. E. Anthony of Moravia, 
New York, to join me. He is a member of my class. 

I am going to write Dr. Rowland today. We all thought a great deal of him as a 
teacher and a friend. 

Hoping to see you in June and wishing you the compliments of the season, I am 

Fraternally yours, 

M.D. Lipes, Class of 1901, B.M.C. 
1440 Broadway 
Watervliet, New York 

February 11, 1951. 
I am cleaning house but hesitate to throw away my Bulletins before learning if 
you have any use for them. If you have, I will be glad to take them over to the 
library the next time I go to Baltimore. 

Very truly yours, 

H. B. McDonnell, class of 1888, P & S 
7400 Dartmouth Avenue 
College Park, Maryland 
(Ed. Note: The Medical Library is ahvays grateful for such valuable contributions.) 



xiv BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

December 11, 1950 
Please accept my thanks for the beautiful fifty year certificate issued by the 
Alumni Association which was presented to me in person June 9th. I also apologize 
for the delay in doing so. 

Very sincerely yours, 

G. Allen Troxell, class of 1900, B.M.C. 
1622 Charlotte Street 
Sarasota, Florida. 

February 9, 1951 
I wish to thank the Medical Alumni Association for placing my picture in the 
October number of our Bulletin of the School of Medicine. My son and I are deeply 
appreciative of the fine compliment. 

.... The likenesses (of all — Ed.) are good and faithful, and you all look happy. 
The slightest turn of the mind takes me back in memory to my beloved Library 
in Davidge Hall, within whose walls I worked happily for over thirty- two years 
and laid the foundations of many precious friendships. You were all marvelous to 
me, and I owe you an eternal debt of gratitude. I was happy in my library work, and 
I am happy in my leisure. I have nothing left to wish for. I feel as though I have 
"warmed my hands at the fire of life". God bless you all! 
With deep affection from your devoted librarian and friend, 

Ruth Lee Briscoe, Librarian Emeritus 






OBITUARIES 

IBv. glfaertu* Cotton 

Dr. Albertus Cotton, professor emeritus of orthopedic surgery and roentgenology 
at the University of Maryland School of Medicine, died May 3, 1951, after an illness 
of several weeks. 

Dr. Cotton was born in Marysville, Kansas, on September 23, 1872. He attended 
Ohio University and received the M.A. degree there in 1891, after which he came to 
Baltimore and entered the College of Physicians and Surgeons where he was gradu- 
ated with honors in 1896. After graduation he served his internship at City Hospital 
(now Mercy Hospital) from 1896 to 1898. 

A pioneer in the study of roentgenology, an orthopedic surgeon and an educator 
for almost half a century, Dr. Cotton was active in his profession until declining 
health forced his retirement several years ago. 

In 1906 Dr. Cotton went abroad, studying in Berlin and Vienna and returning to 
begin his long association with the University of Maryland School of Medicine. 

Until the time of his retirement, he was professor of roentgenology and orthopedic 
surgery at the University of Maryland, attending orthopedic surgeon at Mercy 
Hospital, and visiting orthopedic surgeon at Kernan's Hospital for Crippled Chil- 










DR. ALBERTUS COTTON 

XV 



xvi BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

dren. He conducted orthopedic clinics for crippled children at Snow Hill and Salis- 
bury, Maryland for 15 years. 

Dr. Cotton was a member of numerous medical societies and the author of numer- 
ous papers on orthopedic surgery and roentgenology. 

His wife, the former Florence Brown of Baltimore survives. 

Br. Jfrancts Jfl. Jfflatulattts (lait) 

Dr. Francis M. Lait, class of 1907, Baltimore Medical College, died at his home 
at 7829 Euclid Avenue, Cleveland, Ohio, on January 31, 1951. 

Born in Lithuania in 1876, he came to this country in 1902 and entered the Balti- 
more Medical College the following year. After his graduation, he settled in Boston, 
Massachusetts where he practiced until 1919. After a period of post-graduate train- 
ing, he moved to Cleveland, Ohio, where he practiced ophthalmology from 1933 
until his death. 

Br. lUagfjmgton Hec Jfflacfe 

Dr. Washington Lee Mack, class of 1892, College of Physicians and Surgeons, of 
Walla Walla, Washington, died on September 17, 1949, aged 81, of coronary throm- 
bosis. 

Dr. Mack practiced at Cordova, South Carolina, for over 55 years and was retired 
but a short time prior to his death. 

Br. Ctjarles 8. &nox 

Dr. Charles A. Knox, class of 1904, B.M.C., died on March 9, 1951, at the Hacken- 
sack Hospital, Hackensack, New Jersey, aged 72. 

Dr. Knox was a former president of the Ridgefield Park Trust Company and was 
a member of the staffs of both the Hackensack Hospital and the Holy Name Hos- 
pital in Teaneck, New Jersey. 

Br. Jfratufe 1L. $aglt 

Dr. Francis L. Bagli, class of 1921, died at his home in Baltimore on March 12, 
1951, aged 54. 

A native of Italy, Dr. Bagli came to this country at the age of 2 and spent his 
childhood in Paterson, New Jersey. In 1921 he was graduated from the School of 
Medicine, serving his internship at Baltimore City Hospitals. After a short period 
of general practice, he specialized in obstetrics. He was a member of the staffs of 
St. Agnes, Maryland General, and Bon Secours Hospitals. Aside from his medical 
accomplishments, Dr. Bagli was a talented musician. 

DR. FRANKLIN B. ANDERSON 

Dr. Franklin B. Anderson passed away very suddenly at his home, 8419 Loch 
Raven Boulevard, Baltimore, Maryland, on Tuesday, January 23, 1951. 

Dr. Anderson was born on August 31, 1886, at Monkton, Maryland, the only 
son of Charles W. and Ozello B. Anderson. His early education was obtained in 
the Baltimore County Schools and his high school training at the Baltimore Poly- 
technic Institute. He entered the University of Maryland School of Medicine in 
1912, and was awarded his M.I), degree in 1916. 



OBITUARIES xvii 

Soon after graduation, Dr. Anderson became interested in diseases of the Eye, 
Ear, Nose and Throat and practiced this specialty until his death. He was an active 
and interested teacher in the School of Medicine, beginning as an Assistant in 
Otolaryngology, being promoted to Associate, Assistant Professor, and then to 
Associate Professor of Otolaryngology, which title he held at the time of his death. 
Dr. Anderson was a member of the Staff of the University Hospital and Consulting 
Aurist and Laryngologist for the Kernan Hospital, Baltimore. For years he had 
been in charge of Otolaryngology at the Maryland House of Correction. 

Dr. Franklin Anderson had a distinguished career in the Military Service of his 
country. He was commissioned a First Lieutenant in the Medical Corps June 29, 
1916, and was called to service January 6, 1917, during the Mexican Border Inci- 
dent. During World War I he was promoted to Captain and commanded the 113 
Ambulance Company of the Centre Section in France at Haute Alsace, Meuse, and 
Argonne. He was honorably discharged on June 23, 1919, after serving overseas 
from July 5, 1918 to May 22, 1919. Returning to Maryland, he continued his Army 
Service with the Maryland National Guard, holding successively the ranks of 
Major, Lieutenant Colonel, and Colonel, retiring January 31, 1940, as Brevet 
Colonel. 




DR. FRANKLIN B. ANDERSON 



xviii BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

On December 2, 1916, he married Miss Wilma M. Schmitt. A daughter and only 
child, Phyllis, was born on May 2, 1922. Phyllis is now a Medical Artist employed 
at the Walter Reed Hospital in Washington, D. C. 

As a kind, considerate physician loved by his patients and friends, he will be 
greatly missed by all who knew him. 

Edward A. Looper, M.D. 

DR. JOHN GIRD WOOD 

Dr. John Girdwood, class of 1894, Medical Examiner for the City Service Com- 
mission for many years, died on September 25, 1950, at Baltimore, Maryland, 
aged 79. 

Born in the Barbados, West Indies, he came to Baltimore as a child. Following 
his graduation from the School of Medicine, he served in the Federal Government 
and was then appointed examining physician for the city, being the first physician 
appointed in connection with the administration of the local Merit System. 

DR. WILLIAM C. LOWE 

Dr. William C. Lowe, class of 1941, died at the University Hospital on February 
4, 1951, of injuries received in an automobile accident. 

Dr. Lowe, 33, who was engaged in practice near Centreville, Maryland, was a 
native of Stevensville, Maryland. He served his rotating internship at Mercy Hos- 
pital, Baltimore, from where he entered the Army, serving as a Captain in the 
Medical Corps from 1944 to 1946. 

DR. GIDEON TIMBERLAKE 

Dr. Gideon Timber lake, formerly Professor of Urology at the School of Medicine 
and a founder of the American Board of Urology, died at St. Petersburg, Florida 
on March 1, 1951. 

A graduate of the University of Virginia, Dr. Timberlake was active for many 
years in Baltimore, serving on the staffs of St. Agnes and Franklin Square Hospitals 
and the Church Home and Hospital. 

DR. WILLIAM GWYNN QUEEN 

Dr. William Gwynn Queen, class of 1908, aged 67, died at his home in Baltimore 
on January 3, 1951, of a heart attack. 

Dr. Queen was born in Bryanttown, Charles County and was a graduate of Rock 
Hill College in ElUcott City. 

Following his graduation in the School of Medicine, he interned at the University 
Hospital, later limiting his practice to pediatrics, becoming Pediatrician-in-Chief 
at Bon Secours Hospital with membership on the staffs of Mercy, St. Agnes and 
St. Joseph's Hospitals, Baltimore. 

He is survived by his wife, two daughters and a son. Dr. J. Emmett Queen of the 
class of 1943. 



OBITUARIES 




DR. WILLIAM GWYNN QUEEN 



DR. MOSES LICHTENBERG 

Dr. Moses Lichtenberg, class of 1912, died on December 26, 1950. He was born 
in Baltimore, graduated from the Baltimore City College, and obtained his medical 
degree from the School of Medicine, University of Maryland. 

In World War I Dr. Lichtenberg was a member of the Medical Corps of the 
United States Army. During his long Career he was constantly associated with 
the activities of the Athletic Department of the Baltimore City College serving 
for many years as team physician, an appointment through which he was rewarded 
only by the satisfaction of assistance to the youth of Baltimore. 

From 1930 until his retirement in 1948 it is said that he rarely, if ever, missed 
a game, being constantly with the City College athletic teams. At the close of the 
1948 season he was awarded a rising ovation and a Varsity letter by the student 
body of the City College. 

DR. JAMES HERBERT WILKERSON 

Dr. James Herbert Wilkerson, class of 1921 and former Associate Professor at 
the School of Dentistry, died in Baltimore on December 22, 1950 aged 53. He had 
been in poor health following a heart attack three years ago. 



xx BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

Abramovitz, Morris, Baltimore, Md.; B.M.C., class of 1906; aged 71; died, Febru- 
ary 7, 1951, of cerebral hemorrhage. 

Carpenter, Eugene H., Oneida, N. Y.; P & S, class of 1894; aged 81; died, Novem- 
ber 21, 1950, of chronic myocarditis. 

Culverhouse, John Burnett, Baltimore, Md.; class of 1914; aged 59; died, recently, 
of acute coronary occlusion and hypertension. 

Driscoll, William Thomas, Norwich, Conn.; P & S,»class of 1912; aged 64; died, re- 
cently, of coronary thrombosis. 

Esker, Harry Hood, Clarksburg, W. Va.; P & S, class of 1906; aged 66; served during 
World War I; died, January 23, 1951, of heart disease. 

Gallion, William Edwin, Jr., Darlington, Md.; class of 1912; aged 64; died, recently, 
of coronary thrombosis. 

Gardiner, William Robert, Herrin, 111.; class of 1910; aged 65; died, February 13, 
1951, of cerebral hemorrhage. 

Gott, Ernest Fred, Charleston, W. Va.; P & S, class of 1915; aged 63; served during 
World War I; died, December 31, 1950, of heart disease. 

Gurley, Hubert Taylor, Baltimore, Md.; class of 1925; aged 51; died, recently, of 
coronary thrombosis, arteriosclerosis and diabetes mellitus. 

Hartshorne, George Ewing, Tulsa, Oklahoma; class of 1893; aged 83; served during 
World War I; died, January 19, 1951, of arteriosclerotic heart disease. 

Kelley, James Turner, Rixeyville, Va.; B.M.C., class of 1893; aged 86; died, Decem- 
ber 22, 1950, of congestive heart disease. 

Hess, James Mercer, Tylersburg, Pa.; P & S, class of 1905; aged 67; served during 
World War I; died, January 21, 1951, of myocarditis. 

Kafer, Oswald Ottmar, Edward, N. C; class of 1905; aged 70; died, January 28, 1951, 
of coronary thrombosis. 

Mace, Charles Herbert, West Springfield, Mass.; B.M.C., class of 1900; aged 79; 
died, December 10, 1950, of arteriosclerosis. 

Matthews, Alva Adair, Oak Hall, Va.; class of 1910; aged 66; died, December 31, 
1950, of cerebral hemorrhage and arteriosclerosis. 

Milliken, Walter S., Madison, Me.; B.M.C., class of 1897; aged 80; died, November 
20, 1950, of cardiovascular disease. . 

Missildine, John Gurley, Wichita, Kansas; class of 1911; aged 66; served during 
World War I; died, January 30, 1951, of coronary thrombosis. 

Robertson, Wilburn Burdett, Burnsville, N. C; B.M.C., class of 1898; aged 76; 
died, January 6, 1951, of carcinoma. 

Roop, William P., Absecon, N. J.; class of 1907; aged 71; died, December 27, 1950, 
of cerebral hemorrhage. 

Ross, Samuel Boyd, Philadelphia, Pa.; B.M.C., class of 1912; aged 69; served during 
World War I; died, October 25, 1950, of chronic myocarditis. 

Saul, Henry Wilson, Kutztown, Pa.; B.M.C., class of 1894; aged 81; died, February 
12, 1951, of carcinoma of the pancreas. 

Schneider, Charles Augustus, Newark, N. J.; B.M.C., class of 1900; aged 74; died, 
February 2, 1951, of lymphoblastoma. 



OBITUARIES xxi 

Stuart, LeClare, Rome, N. Y.; P & S, class of 1908; served during World War I; 
aged 67; died, December 22, 1950, of injuries received in an automobile acci- 
dent. 

Swank, Peter L., Boalsburg, Pa.; P & S, class of 1889; aged 88; died, December 5, 
1950, of carcinoma of the rectum. 

Tumbleson, Charles Cumming, Sandy Spring, Md.; P & S, class of 1905; aged 72; 
died, November 30, 1950, of carcinoma of the kidney. 

Tweedie, Hedley Vicars, Rockland, Me.; B.M.C., class of 1897; served during World 
War I; aged 84; died, December 6, 1950, of carcinoma of the colon. 

Walsh, John Edward, Revere, Mass.; B.M.C., class of 1898; aged 77; died, Novem- 
ber 8, 1950, of heart disease. 

Wilkerson, James Herbert, Baltimore, Md.; class of 1921; aged 53; died, December 
22, 1950, of heart disease. 

Williams, James Owen, Alderson, W. Va.; P & S, class of 1914; aged 67; died, De- 
cember 4, 1950, of cerebral hemorrhage. 

Aptaker, Albert J., Forest Hills, N. Y.; class of 1927; aged 47; died, October 19, 1950, 
of coronary occlusion. 

Devlin, Hugh Joseph, Newark, N. J.; B.M.C., class of 1905; aged 77; died, October 
24, 1950. 

Dobson, James Furman, Ridgeway, S. C. ; class of 1914; aged 59; served during World 
War I; died, September 22, 1950, of cancer. 

Douthirt, Cranford H., Santa Fe, New Mexico; class of 1914; died, December 1, 
1950, of coronary occlusion. 

Foster, Ruth, New York, N. Y.; class of 1931; aged 56; died, September 29, 1950, of 
carcinoma. 

Galligan, Edward Joseph, Taunton, Mass.; P & S, class of 1896; aged 81; died, Sep- 
tember 25, 1950, of arteriosclerotic heart disease. 

Halliday, Charles H., Baltimore, Md.; P & S, class of 1904; aged 70; died, September 
30, 1950, following a gallbladder operation. 

Hershner, Newton W., Mechanicsburg, Pa.; class of 1906; aged 72; died, October 8, 
1950, of coronary occlusion. 

Jaffe, Benjamin Meyer, Baltimore, Md.; class of 1916; aged 55; died, recently. 

MacConnell, John Wilson, Davidson, N. C; class of 1907; aged 72; served during 
World War I; died, September 26, 1950, of carcinoma. 

Stevens, Thomas H., San Diego, Calif.; B.M.C., class of 1893; aged 89; died, October 
17, 1950, of carcinoma of the colon. 

Walsh, John E., of Revere, Massachusetts, B.M.C., class of 1898, died on Novem- 
ber 8, 1950, at the age of 78. 




FRATERNAL NEWS SECTION 

ALPHA OMEGA ALPHA 

During the past six months the Beta Chapter of the Alpha Omega 
Alpha Honorary Medical Society has enjoyed an active and productive 
period in the extra-curricular events of the School of Medicine. An 
annual fall banquet took place on December 8, 1950. Dean H. Boyd 
Wylie, a member of Beta Chapter was the speaker of the evening. 
His topic was entitled "Medical Education and Its Problems." 

Three business meetings were held during the month of March, 
1951, at which time, policies of the Society were studied; and activi- 
ties which may benefit the University at large were discussed. 
A series of 3 lectures, dealing with the doctor and society was sponsored by the 
Society. These open lectures were given in the Gordon Wilson Hall, University Hos- 
pital, at 5 P. M. The lectures and their respective dates are listed: 

Dr. Maurice C. Pincoffs, Professor of Medicine; Medical Ethics; Mar. 27, 1951. 
Dr. John C. Krantz, Professor of Pharmacology and Head of the Department; 
The Doctor and the Population; Apr. 3, 1951. 

Dr. Jacob E. Finesinger, Professor of Psychiatry and Head of the Department; 
Recent Trends in Medical Education; Apr. 10, 1951. 

On May 2, 1951, Beta Chapter held its second annual Spring Banquet. At the 
meeting, three senior students, Messrs. J. H. Stone, Charles P. Watson, Jr., and Rob- 
ert D. Weekley were initiated. Also 5 junior students were initiated. These included 
Messrs. Charles B. Adams, Richard E. Ahlquist, Daniel Clyman, William Mathews 
and Alvin Stambler. The following alumni were also initiated as members of this 
Chapter: Dr. William Long, class of 1937, and at present a practicing surgeon in 
Salisbury, Maryland, and Dr. J. Hornbaker, class of 1930, a practicing internist at 
Hagerstown, Maryland. 

The newly appointed officers for the coming year were announced: 
President: William Mathews 
Vice-President : Alvin Stambler 
Assistant Secretary: Daniel Clyman 
The offices to be continued are Counselor: Dr. John E. Savage; and Secretary- 
Treasurer: Dr. Milton S. Sacks. The evening was made memorable because of a 
most stimulating and instructive lecture given by Dr. William Dameshek, Professor 
of Clinical Medicine, Tufts College Medical School. The title of his talk was "The 
Blood, The Spleen, and The Bone Marrow. ,J The lecture was open to the medical 
profession and was well attended. This lecture by Dr. Dameshek was the first of a 
series of annual talks to be given by well known members of the profession and 
sponsored by Beta Chapter. The chapter sincerely hopes that the lectures to follow 
will realize the success of the initial experience. 

In an attempt to stimulate the interest of both students and faculty in academic 
fields in which students may participate, Beta Chapter terminated its school year 



FRATERNAL NEWS SECTION xxiii 

with a group of 6 papers delivered by senior students of the University of Maryland. 
These papers represented extra-curricular work in the academic fields of medicine, 
in which the speakers were privileged to participate. The detailed program follows. 

Program of Student Research Papers 

University of Maryland School of Medicine 

Gordon Wilson Hall 

May 16, 1951 

Sponsored by Beta Chapter, Alpha Omega Alpha Society 

1. Preliminary Study of Distribution of a Naturally Occurring Hemagglutinins in Human Sera, 
David Kipnis; Discussion by Dr. Milton S. Sacks 

2. Preliminary Study of Personalities of Medical Students by Use of Rorschach Test, Jack Leib- 
man and Fred Johnson; Discussion by Dr. Jacob E. Finesinger 

3. A Personality Stud}- of Junior High School Problem Children, Jack Liebman; Discussion by 
Dr. Jacob E. Finesinger 

4. Convulsant and Anticonvulsant Effects of Some Antihistaminic Drugs, William G. Esmond; 
Discussion by Dr. Harold E. Himwich, Chief, Clinical Research Branch, Medical Research Division, 
Army Chemical Center, Maryland 

5. Cardiovascular Responses to Tilting and Standardized Exercise in Young and Old Males, 
Charles Ferguson; Discussion by Dr. Dietrich Smith, Department of Physiology 

6. An In- Vivo Antibiotic Protection Study Against Leptospirosis Icterohemorrhagica, Leonard 
Lister; Discussion by Dr. T. E. Woodward 

All junior and senior classes were suspended, and the student body and faculty 
were invited. Dr. Milton Sacks acted as moderator. It is hoped by the Society that a 
similar series of papers may be given annually. 

PHI DELTA EPSILON 

Recently the fraternity has had the pleasure of serving as 
host to several distinguished lecturers. Dr. Louis Soffer, of 
Columbia University School of Medicine, delivered the an- 
nual Phi Delta Epsilon, guest lectureship at the School of 
Medicine. His discussion of the physiology and clinical ap- 
plications of ACTH was warmly received by a large audi- 
ence. Dr. Helen Taussig and Dr. Emanuel Schoenbach, both 
of Johns Hopkins, delivered lectures at the house during the 
regular monthly scientific meetings. Dr. Taussig's lecture 
concerned persistent truncus arteriosus, and Dr. Schoenbach 

spoke on the selective use of antibiotics. 

At recent elections, Alvin Stambler was elected consul to succeed David Kipnis. 

Other officers chosen were: Joseph Schuman, vice-consul; Norman Miller, secretary; 

Jonas Rappaport, treasurer; Leonard Glick, historian. 
Three members of the fraternity deserve special mention. Alvin Stambler and 

Daniel Clyman have become members of Alpha Omega Alpha honorary fraternity. 

Israel Weiner has been awarded the Aaron Brown prize for the best scientific paper 

submitted by a member of the national fraternity. 




xxiv BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

The graduate club of this city is now under the leadership of Dr. Louis Blum of 
the Department of Medicine. At the last national convention in New York, Dr. 
Samuel S. Glick of the Department of Pediatrics, was elected to the office of Vice- 
Grand Consul; and Dr. I. A. Siegel of the Department of Obstetrics, was appointed 
District Deputy Grand Consul to supervise chapters in this region. 

Dr. David Silberman recently led a gynecology symposium at Johns Hopkins and 
Sinai Hospitals. The symposium was sponsored by the Gynecology Club, composed of 
fraternity members throughout the nation. A similar event takes place each year in a 
major city. 

In April Dr. Ephraim Lisansky of the Department of Medicine and Psychiatry, 
delivered a lecture in Arlington, Virginia, entitled "Psychosomatics in Cardiovascular 
Diseases." 

Dr. Albert E. Goldstein, of the Department of Urology and Pathology, was a dis- 
cussant of papers delivered in April before the Mid-Atlantic section of the American 
Urological Association. He will also discuss papers in June at the national meetings 
of the A.U.A. in Chicago, and of the A.M.A. in Atlantic City. 



NU SIGMA NU 

Dr. Jacob W. Bird, class of 1908, recently visited the 
house and presented a large, framed picture of his class 
to be hung on the wall. 

The annual Spring Formal was held at the Stafford 
Hotel on April 7, 1951, and was well attended. 

All Alumni Brothers are invited to see the new and 
valuable bookcase purchased for the house library. 

On April 25, 1951, a smoker was held for pledges. 

Among the Alumni attending were: Drs. T. Conrad 

Wolff, 1917, Dr. Ernest I. Cornbrooks, Jr., 1935, Dr. 

Edward F. Cotter, 1935, Dr. Karl F. Mech, 1935, and Dr. John A. Wagner, 1938. 

The attending Alumni each gave a few valuable words to the new pledges. 





phases of 



PHI BETA PI 

There will be twelve Phi Beta Pi members in this year's 
graduating class. The last time a Phi Beta Pi graduated from the 
School of Medicine was in 1940. In the years to come, this number 
will become much larger. 

The annual initiation ceremony was held in February, and 25 
pledges were accepted as members of the fraternity. At the first 
meeting after the initiation, a plan was inaugurated which called 
for a dinner, business meeting, and seminar to be held on the first 
Friday of every month. A guest speaker is invited to each of these 
sessions so that the clinical aspect of important diseases might 
be presented along with student speakers who cover various 
the topics selected. 



FRATERNAL NEWS SECTION xxv 

In March, 1951, Dr. Emil Novak, a Phi Beta Pi, gave an interesting talk to fra- 
ternity members and their guests. His topic was "Primary Dysmenorrhea". An 
interesting question and answer discussion of this topic followed Dr. Novak's speech. 
Fraternity officers are planning to hold similar meetings during the coming year. 

A picnic was held on the last Sunday of April at Dr. Theodore Kardash's shore 
home. Phi Beta Pi hopes to make this one of its big annual events. 

The Chapter Library is progressing slowly, and we wish to thank those who have 
made contributions. Alumni of Phi Beta Pi are solicited for contributions of books 
and Journals. The mailing address is in care of the School of Medicine. 




OF 

THE SCHOOL OF MEDICINE 

UNIVERSITY OF MARYLAND 

volume 36 October j 1951 NUMBER 4 

THE EFFECT OF CORTISONE IN THE TREATMENT OF 
TYPHOID FEVER*f 

THEODORE E. WOODWARD, M.D., JOSEPH E. SMADEL, M.D. and 
ROBERT T. PARKER, M.D. 

The control of infectious diseases has progressed markedly in the last few decades 
as a result of the control of the microbial causes of disease. We are now entering an 
era when emphasis is shifting from the microbial agent to the host. 

The use of ACTH and cortisone in the collagen diseases and in those of endocrine 
or hypersensitive origin is well known. Moreover, the momentous contributions of 
Kendall, Hench, Thorn and Harvey pertaining to cortisone and ACTH have again 
reemphasized the importance of the host factor. Indeed, Finland and his collaborators 
observed that during the course of pneumococcal pneumonia the patient receiving 
ACTH was rendered free of symptoms in spite of continued bacteremia. Our interests 
have been directed toward typhoid fever. 

Clinicians need hardly be reminded of the two mechanisms that damage typhoid 
patients. These are: 1 — a septicemic disease with local lesions throughout the body 
certain of which are prone to accidents, for example, hemorrhage and perforation of 
the intestinal ulcer and: 2 — a severe toxemia which is more difficult to define but is 
apparent to all clinicians. In 1926 Jaffe and Plaske noted that in the absence of 
accessory cortical tissue adrenalectomized rats were highly susceptible to the toxic 
effects of typhoid vaccine for as long as 5 months after the operation. They noted that 
autoplastic cortical transplants protected adrenalectomized rats against the typhoid 
toxin in amounts otherwise lethal. Subsequently the protective action of cortisone 
against the shocking action of typhoid toxin in adrenalectomized rats was clearly 
demonstrated by Lewis and Page. 

Clinical investigators interested in chemotherapy of acute infectious diseases have 
not been fully satisfied with the therapy of typhoid fever. Despite the obvious 
benefits of chloramphenicol therapy in typhoid, there are several problems which 
remain to be solved: 1 — the present chloramphenicol regimes do not alleviate the 
toxemia of the disease for at least 36-48 hours and fail to eliminate the fever until 

* This paper presented to the General Session of the American College of Physicians, St. Louis, 
April 12, 1950. 

f Received for publication July 3, 1951. The contribution of numerous individuals to this study 
was acknowledged in previous publications (1, 2). 

143 



144 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

the fourth day; 2 — relapses of typhoid fever occur in a certain portion of treated 
cases; 3 — S. typhosa continue to be shed in the feces for a variable though usually 
short period of time after therapy is begun; and 4 — the typhoid carrier state, when 
it exists, is not permanently benefited by chloramphenicol. 

This present report extends the previously published results pertaining to the clini- 
cal observations in patients receiving combined therapy with chloramphenicol and 
cortisone and in other patients in whom cortisone was the sole form of treatment 
(1, 2). It should be mentioned immediately that the hormone, while producing ob- 
vious benefits to the patients, exerted no anti-bacterial effect and did not significantly 
hasten the disappearance of 5. typhosa from the blood or feces. 

METHODS OF STUDY 

A. Selection of Patients. Patients with typhoid fever proved by cultivation of 
6". typhosa from the blood or feces were selected for treatment using chloramphenicol 
in combination with cortisone or cortisone alone. 

TREATMENT 

A. Combined chloramphenicol and cortisone. Chloramphenicol was administered 
orally at 8-12 hour intervals with a large initial dose of approximately 50 mg./kg. 
and subsequent daily doses computed on the same basis. After improvement ensued 
the daily dose of chloramphenicol was halved for a total of approximately 10 days. 

Cortisone was administered by two different dosage schedules. The first schedule 
consisted of 200 mg. the first day and 100 mg. for each of the next 2 days. The second 
schedule was 300 mg. the first day, 200 mg. the second and 100 mg. the third day. 
It may be seen, therefore, that cortisone was administered for a relatively short period 
of time during the course of this illness. 

B. Cortisone alone. In the 4 adult patients cortisone was given in doses of 200 mg. 
the first 24 hours in divided doses of 100 mg. each. During the second 24 hours, 200 
mg. were administered and on the third day 100 mg. The children, aged 5, 7, 8 and 11, 
were given approximately one-half the adult dose. One patient who suffered a relapse 
received a second course of cortisone. 

C. Care of patient. Clinical and laboratory procedures were essentially the same as 
those employed in earlier studies by our group. 

Chloramphenicol blood levels were performed on a sufficient number of cases to 
indicate that the results were similar to those obtained on essentially identical 
regimes. 

Daily blood cultures were obtained during the pre-treatment observation period 
and frequently, usually daily, for one week after instituting therapy. Specimens of 
feces and urine were cultured for 5". typhosa at frequent intervals throughout the 
period of observation. 

The Widal reaction was determined on several specimens from each patient. The 
blood was examined by routine hematologic methods but it was not possible under 
the conditions of the study to determine the absolute eosinophil count or serum 
electrolyte pattern with any uniformity. Seventeen ketosteroids were not deter- 
mined. 



WOODWARD ET AL— CORTISONE AND TYPHOID FEVER 145 

RESULTS 

It is worth recounting that our previous experience with the use of chloramphenicol 
in the treatment of 44 patients with typhoid fever showed that an average of 4 days 
was required from the time the first antibiotic was given until fever and toxemia 
disappeared. It is surmised that this delayed clinical response depended upon libera- 
tion of toxin from destroyed bacteria and also upon the liberation of toxic products 
from the basic necrotic lesion in the intestine. Nevertheless, the 4 day interval of 
toxemia and fever appear to be a fairly constant finding in typhoid patients who 
receive only chloramphenicol. 

A. Effect of Combined Chloramphenicol and Cortisone Treatment. A summary of the 
observations on the duration of fever after beginning treatment of typhoid in: 1 — 44 
patients with chloramphenicol; 2 — 16 with chloramphenicol and cortisone; and 3 — 7 
with cortisone is given in Table I. The table shows that in the 44 typhoid patients 
treated with chloramphenicol alone, the average duration of fever after beginning 
therapy was 84 hours. This febrile period coincides closely with the findings of sub- 
sequent investigators. It will be noted in this table, that of 16 patients receiving com- 

TABLE I 

Effect of therapy on febrile course of typhoid fever patients 



NO. OF PATIENTS 


TREATMENT 


DURATION OF FEVER 
AFTER R< 


44 
16 

7 


Chloramphenicol 
Chloramphenicol Cortisone 
Cortisone 


{hours) 

84 
26 
40 



bined treatment with chloramphenicol and cortisone that the average duration of 
fever was 26 hours. Moreover, in 7 patients receiving cortisone alone for the primary 
febrile course, the duration of fever was 40 hours. The results obtained, therefore, 
show consistent improvement over the findings in patients treated solely with chlor- 
amphenicol. 

Combined treatment was followed in all instances by objective and subjective 
improvement within approximately 18 hours after instituting therapy. At this time 
all patients displayed interest in their surroundings and temperatures began to fall. 
Within 15 hours the findings in those patients receiving larger doses of cortisone were 
striking. All were afebrile and showed alertness and increased appetite. 

Complications of Combined Therapy. The usual incidence of intestinal hemorrhage, 
intestinal perforation and relapse in typhoid fever is 3 per cent, 7 per cent and 9 per 
cent respectively. In the group of 16 patients who received chloramphenicol and 
cortisone, there were no perforations although one developed a moderately severe 
gastro-intestinal hemorrhage. The occurrence of six relapses (38 per cent) in a group 
of 16 patients therefore represents a higher rate than normally expected in this dis- 
ease. The relapse of these patients responded satisfactorily when chloramphenicol 
was again administered. It has been previously noted that a high relapse rate results 



146 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



when chloramphenicol was administered for 8 days or less, in the neighborhood of 50 
per cent, whereas few were encountered when therapy was continued for 2 weeks. 

ILLUSTRATIVE CASE REPORTS 

1. Treatment with Chloramphenicol Alone. Figure 1 graphically represents the course 
of typhoid fever in a patient who received chloramphenicol alone. The patient, 
seriously ill, received chloramphenicol on the seventh day of disease. It will be noted 
that the temperature reached normal levels in approximately 4 days and in this pa- 
tient there was little improvement of the toxic state until the third day of therapy. 
Convalescence progressed quite satisfactorily and it will be noted that repeated 



patient s , male, age is 

I20LB 




DAY OF DISEASE 



CULTURE 



Fig. 1. Course of typhoid in a 15 year old patient treated with chloramphenicol 

blood, stool and urine specimens were negative for S. typhosa after therapy was in- 
stituted. There was no relapse encountered in this patient. 

2. Combined Treatment with Chloramphenicol and Cortisone. 

Figure 2 graphically represents the course of typhoid in a 13 year old girl who was 
admitted to the hospital on the tenth day of an illness characterized by chills, fever 
of 106 F and abdominal pain. Typhoid bacilli were cultured from specimens of blood 
obtained prior to initiation of treatment on the twelfth day of disease. Within 18 
hours after beginning treatment when she had received a total of 300 mg. of corti- 
sone and 7 gm.of chloramphenicol, the patient was noticeably improved and alert. 
The temperature reached normal limits within 24 hours and remained normal there- 
after. The illness was not complicated during convalescence and the course was one 
of progressive improvement. Further attempts to culture S. typhosa from specimens 
of blood and feces were negative. 

3. Combined Treatment with Chloramphenicol and Cortisone 



WOODWARD ET AL.— CORTISONE AND TYPHOID FEVER 



147 



The course of typhoid in a 27 year old patient is graphically represented in Figure 
3. The patient, who was seriously ill and had a bacteremia, showed gross intestinal 



PATIENT R.S. FEMALE AGE 13 
TYPHOID FEVER 




10 I! 12 13 14 15 16 17 18 19 20 



S. TYPHOSA 
CULTURE 


BLOOD + + 00 


STOOL 



DAY OF DISEASE 

Fig. 2. Graphic record of. a 13 year old typhoid patient treated with cortisone and chloram- 
phenicol. 



N-30, MALE. AGE 27 
47 KG 









e 7 ' ,., T1 65 ., 52 


H68 GM% 


,0 ,, 


S 
C 


YPHOSA 
LTURE 


BLOOD 


♦ 


♦ 





























STOOL 


t 


































URINE 

































Fig. 3. Course of typhoid in a 27 year old man treated with combined cortisone and chlor- 
amphenicol. Intestinal bleeding persisted for 15 days. 

bleeding prior to the initiation of specific therapy. The rapid return of the temperature 
to normal on combined treatment with cortisone and chloramphenicol may be ob- 
served. Indeed, the patient's bedside appearance was noticeably improved before 
the temperature reached normal. It will be observed furthermore that gross intestinal 



148 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



bleeding occurred for 9 days during the course of disease. This is not unusual during 
typhoid but the point nevertheless must be considered as to whether cortisone may 
have been a factor in continuation of bleeding by delaying healing. 

B. Effect of Treatment with Cortisone Alone. 

The effect on the febrile course constitutes striking evidence that cortisone therapy 
influences the course of typhoid. Examination of Table II reveals that in 7 of 8 pa- 
tients cortisone therapy alone was followed by a fall of temperature to normal levels 
within 16-73 hours, the average being 40 hours. Furthermore, objective and subjective 
improvement was uniformly observed within the first 24 hours of treatment. There 
was abatement of headache, weakness and mental dullness within this period. Four 
patients were in a semi-stuporous state with profound toxemia which characterizes 
typhoid fever. These patients were all markedly improved within 24-36 hours. In 
one patient there was no demonstrable effect upon the febrile course although his 
clinical appearance was strikingly improved after 24 hours of cortisone therapy. 
Chloramphenicol given a week later produced defervescence. 

TABLE II 
Results of cortisone therapy in 8 patients with typhoid fever 



NO. OF PATIENTS 


CORTISONE 


DURATION! OF FEVER 
AFTER R 


RELAPSE 


DURATION OF BAC- 
TEREMIA 


4 

3 

1 


Mg 
400 
600 
700 


(Hours) 

18 

73 

No effect 


1 





(Days) 

3 
2 
4 



Effect on the Bacteremia. In 7 patients S. typhosa was isolated from the blood im- 
mediately prior to institution of cortisone therapy. In the remaining patient, bac- 
teremia was not demonstrated until the relapse. In 2 patients blood cultures found 
positive before treatment were consistently negative thereafter. In 5 remaining cases, 
5. typhosa was isolated on the second, fourth and fifth days after beginning cortisone, 
in spite of the fact that the patients during the bacteremic phase were clinically im- 
proved. 

Effect on the Stool Culture. Stool specimens were found positive for S. typhosa in 6 
patients in one or more instances during convalescence. The longest period that stools 
demonstrated typhoid bacilli was the sixtieth day of disease. Xo patient was dis- 
charged without three consecutive stool cultures. Cortisone produced no apparent 
effect on the occurrence of typhoid bacilli in the feces. 

Complication of Cortisone Therapy. Only one of the 8 patients given the hormone 
alone developed a relapse. Three patients in this group received chloramphenicol 
during convalescence because of persistent typhoid bacilli in the feces. This probably 
prevented relapses in their cases. An additional case showed moderate intestinal 
hemorrhage on the fifty-fifth day and pericarditis on the sixtieth day of disease. 

ILLUSTRATIVE CASE REPORTS 

1. Treatment with Cortisone Alone. Figure 4 presents the results obtained with 
cortisone in a 27 year old colored female who was moderately ill with typhoid fever. 
Therapy was initiated on the ninth day of disease and for 5 subsequent days the blood 



WOODWARD ET AL.— CORTISONE AND TYPHOID FEVER 



149 



continued to show typhoid bacilli on culture. Nevertheless, during this time, the 
patient was afebrile and sitting up in bed. Indeed, it was difficult to keep her 'from 
walking about the ward. Convalescence was uneventful and there was no relapse. 

2. Treatment with Cortisone Alone. The patient whose record is summarized in 
Figure 5 was a 7 year old colored child who was rather severely ill with typhoid 
fever. Within 36 hours after starting cortisone the temperature had returned to 



104 -. 
103 - 
102 - 
101 — 
100 - 
99 

98 - 

200 -, 
MGM 
CORTISONE 75ay" i0 °- 




PATIENT C.B. FEMALE AGE 27 
TYPHOID FEVER 



S^y- 



I 3 I 4 ! 5 I 6 



12113 I 14 1 1 5 ■ 16 1 17 1 18 I 126127 1281 

DAY OF DISEASE 



S TYPHOSA 
CULTURE 


BLOOO 


¥~ 


4- 00 + 4-4-4-4-00 00 


STOOL 


0+ +4- ++ 4- 4- 


URINE 


+- + 


WIDAL 





i:320 1160 


H 


l o i:i60 i:320 


E0SIN0PHILES/ CUM;V; 


33 22 39 8 14 14 14 47 22 


SODIUM 


ME 9 


117 


POTASSIUM 


5 35 


CHLORIDE 


91 



Fig. 4. Effect of cortisone in a 27 year old female with moderately severe typhoid. Note per- 
sistence of bacteremia. 



PATIENT T.W MALE AGE 7 
TYPHOID FEVER 




CORTISONE 
MGM 
"DAY" 



S TYPHOSA 
CULTURE 


BLOOO 


+ 4-++ 0+00 










STOOL 


04-4-4- + + 


4-0 4- 





4- 


URINE 





WIOAL 





1 640 1 640 


H 


i so i eo 


EOSINOPHILES/CUMM. 


14 81 14 42 17 


33 53 






SODIUM 


MEQ 
< 


III 128 


129 






POTASSIUM 


42 47 


5.0 






CHLORIDE 


88 94 


90 







Fig. 5. Graphic record of a 7 year old typhoid patient treated with cortisone. Chloramphenicol 
administered during convalescence. 



normal. Even before this time, however, this child who was toxic before therapy was 
instituted stood up in the crib, showed interest in his surroundings and ate heartedly 
On the twentieth day when the patient was asymptomatic, chloramphenicol was 
administered because of the finding of a positive stool culture for typhoid bacilli. 

3. Cortisone Therapy with Relapse. Figure 6 presents the results of treatment of a 
moderately ill patient with typhoid fever who relapsed after cortisone. The tempera- 
ture which was 102 F before institution of therapy, became normal within 16 hours 
after 200 mg. of cortisone. Bacteremia was not demonstrated prior to therapy. After 
10 days during which the patient was entirely free of symptoms, there was a return 
of temperature and typhoid bacilli were isolated from the blood. Re-administration 



150 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



of 300 mg. of cortisone for 2 days resulted in a complete remission of symptoms and 
the course thereafter was uneventful. 



PATIENT D.0. MALE AGE 32 
TYPHOID FEVER 








MOM 2 °0-_ 


r 


1 9 ho' II Il2ll3ll4r*5ll6ll7ll8ll9l20l2l I22l23l24l25 Feel 2 7 l2sl29 1 30 
DAY OF DISEASE 


S TYPHOSA 
CULTURE 


BLOOD 


+ 


STOOL 


+ +0000 + 000000 


URINE 





WIDAL 





1 1280 1 1280 



Fig. 6. Effect of cortisone therapy in typhoid. Note relapse with bacteremia on 26th day of 
disease. 



DISCUSSION AND SUMMARY 

The combination of cortisone with chloramphenicol apparently arrests the acute 
manifestations of typhoid fever more effectively than does the antibiotic alone. 
Sixteen patients acutely ill with typhoid fever were markedly improved within 24 
hours after beginning combined therapy. The average duration of fever in this 
group was 26 hours. This represents a shortening of the febrile period in comparison 
with that obtained with the usual chloramphenicol therapy. 

Cortisone administered as the sole form of treatment in 8 typhoid fever patients 
appeared to exert a favorable influence and resulted in amelioration of symptoms. 

Cortisone lacks any direct effect upon the toxin of 5". typhosa. Furthermore, this 
hormone possesses no direct effect on the typhoid organism since: 1 — there is no evi- 
dence of bacteriostatic or bacteriocidal effect in in vitro tests of cortisone and S. 
typhosa; 2 — bacteremia and the occurrence of S. typhosa inthefecesare not appreciably 
altered in those patients treated with cortisone alone. It appears likely therefore 
that the beneficial effect of cortisone in the typhoid patient is the result of action on 
the human host rather than directly on the typhoid bacillus or its products. 

In the present group of 24 patients, there were 7 who suffered typhoidal relapses. 
Six of these 7 relapses occurred in the group of 16 patients who received combined 
treatment with cortisone and chloramphenicol. The incidence of relapses in this 
particular group is unusually high. Previous experience had shown that very few 
patients suffer relapse if chloramphenicol is used over a period of 2 weeks. Such a 
schedule was employed here. One must raise the question regarding the possible role 
of cortisone in increasing the relapse rate of patients receiving combined therapy. 
This question can only be answered when the results of additional observations 
become available. However, a number of theoretic considerations are worth mention- 
ing at this time. 

An extensive literature is already beginning to accumulate on the detrimental 
effect of cortisone and ACTH on experimental bacterial infections of animals, 
notably those caused by tubercle bacilli (3) and streptococci (4). Certain of these 
studies, particularly those of Michael and his associates, in tuberculous infections 



WOODWARD ET AL— CORTISONE AND TYPHOID FEVER 151 

have been interpreted as showing a suppression of the immunologic response of the 
host. There is no doubt about the fact that the cortisone-treated animals of Michael 
were more susceptible than the appropriate controls. However, the data might be 
explained on the basis of suppression of cellular response of the infected animal 
rather than on the basis of suppression of immunologic response. In any case, it is 
noteworthy that the untoward effects obtained with cortisone in experimentally 
infected animals are noted only after relatively large doses are employed for a rela- 
tively long time. In the present group of cases, the serologic response (O and H 
agglutinins) of our typhoid patients who received combined therapy or cortisone 
alone was not materially different from that previously observed in patients with 
untreated typhoid or those who received chloramphenicol. 

Another of the physiologic effects of the adrenal hormones which might produce an 
untoward effect in typhoid patients is concerned with the suppression of fibroblastic 
activity (5). It is apparent that an appreciable suppression of this type might ad- 
versely affect the outcome of the necrotic lesions of the intestine. Here again, this 
hormonal effect is manifest after relatively prolonged administration. In this series 
of 24 patients, intestinal hemorrhage occurred in 2 instances (8 per cent) which com- 
pares roughly with the 7 per cent of gross hemorrhage occurring in McCrae's ac- 
cumulated series of 23,271 cases. Nevertheless the hazard of delayed healing and its 
possible increase in the tendency toward spontaneous rupture of the intestinal lesion 
cannot be minimized. 

CONCLUSION 

It is our opinion that cortisone in typhoid fever assists the patient in suppressing 
the toxic manifestations of the disease. The beneficial effects of cortisone are ob- 
tained quickly when adequate doses are administered. Therefore, prolonged therapy 
with the hormone is not indicated; indeed, 1 or 2 days of treatment is probably 
adequate to elicit the maximal benefit as regards this detoxifying effect. Since 
cortisone possesses no direct activity against the typhoid organism, the bacterio- 
static antibiotic chloramphenicol must be used in the rational treatment of typhoid 
fever. Combined therapy with chloramphenicol and cortisone is probably indicated 
only in those patients who display marked signs of toxicity. 

Dept. of Medicine, University of Maryland School of Medicine, 29 S. Greene St., Baltimore 1, Md. 

BIBLIOGRAPHY 

1. Smadel, J. E., Ley, H. L., Jr., Diercks, F. H.: Treatment of typhoid fever. I. Combined therapy 

with cortisone and chloramphenicol. Ann. Int. Med. 34: 1, Jan. 1951. 

2. Woodward, T. E., Hall, H. E., Diaz-Rivera, R., Hightower, J. A., Martinez, E. and Parker, 

R. T.: Treatment of typhoid fever: II. Control of clinical manifestations with cortisone. Ann. 
Int. Med. 34: 10, Jan. 1951. 

3. Michael, M., Jr., Cummings, M. M. and Bloom, W. L.: Course of experimental tuberculosis 

in the albino rat as influenced by cortisone. Proc. Soc. Exp. Biol. & Med. 75: 613-616, Nov. 
1950. 

4. Glaser, R. J., Berry, J. W., Loeb, L. H., Wood, W. B., Jr. and Daughaday, W. H.: Effect of 

ACTH and cortisone in experimental streptococcal and pneumococcal infections. J. Lab. & 
Clin. Med. 36: 826, Nov. 1950. 

5. Howes, E. L., Plotz, C. M., Blunt, J. W. and Ragan, C: Retardation of wound healing by 

cortisone. Surgery 28: 177, Aug. 1950. 



A VIABLE PEDICLE GRAFT FOR REPAIRING INTRATHORACIC 

STRUCTURES*! 

A PRELIMINARY REPORT ON TRACHEAL DEFECTS 

R. SIM PENTON, M.D. and OTTO C. BRANTIGAN, M.D. 

The intimate anatomic relationships of essential structures within the thorax and 
the extension of disease often limits the effectiveness of surgery in this region. It 
has become necessary to perfect methods for repairing structures, portions of which 
must be excised, in order to perform adequate surgery on advanced disease. A viable 
pedicle graft is here described which, it is believed, will be useful for repairing a variety 
of tracheal, vascular, and esophageal lesions inside the chest. In the following study, 
experiences with the use of this graft for repairing experimentally produced tracheal 
defects are reported. 

The possibility of reconstructing the badly damaged trachea has become more 
feasible because of experimental evidence which has accumulated during the past 
decade. The remarkable ability of the trachea to bridge defects with fibrous tissue 
and respiratory epithelium has made it possible to use a wide variety of materials as 
a framework upon which this reparative process may take place. 

Successful repair of the cervical trachea has been reported as early as 1911 (1). 
However, it has been only in recent years, as more intrathoracic diseases are becoming 
amenable to surgical therapy, that methods of repairing the thoracic trachea have 
received widespread interest. Taffel (2) in 1940 used free fascial grafts to close small 
tracheal defects as reported in a group of experiments on dogs. Defects were produced 
in both the cervical and thoracic trachea. The transplants did not appear to remain 
viable but were rapidly replaced by fibrous tissue lined with respiratory epithelium. 
Nash (3) in 1943, while discussing the treatment of injuries to the larynx and trachea, 
agrees that fascia may be useful in bridging defects of this etiology. 

While investigating various uses for polyethylene, Grindly and Mann (4) 
anastomosed the trachea over molded tubes of this material and later removed the 
tubes at bronchoscopy. In 1948 Hanlon (5) used gelatin sponge successfully for 
bridging small defects in the trachea and bronchi. Daniel (6) has reported complete 
regeneration of the trachea about glass tubing. Flattened epithelium completely 
covered the entire luminal wall, and the presence of distinct rings of cartilage approxi- 
mated the appearance of the original trachea. Gebauer (7) has found dermal grafts 
supported with stainless steel wire to be useful for plastic reconstruction of tuber- 
culous bronchostenosis. Gibbon (8) reported a case in which he used a section of costal 
cartilage wrapped in a flap of parietal pleura. 

After reviewing the previous experimental work on this problem, it becomes evident 
that the results obtained have not depended to any great extent upon the material 
used as a graft. These materials serve simply as a framework upon which the tracheal 
wall may regenerate in the form of fibrous tissue and respiratory epithelium. 

* From the Department of Surgery, School of Medicine, University of Maryland. 
| Received for publication September 10, 1951. 

152 



PENTON— PEDICLE GRAFT FOR INTRATHORACIC STRUCTURES 153 

The present experiments differ completely. A rectangular pedicle flap consisting 
of intercostal muscles, periosteum, neurovascular bundles, and parietal pleura is 
mobilized from the chest wall. It is thick, tenacious, and retains an excellent blood 
and nerve supply from the intercostal vessels and nerves which enter its attached 
portion posteriorly. It continues to remain viable and does not at any time depend 
upon fibrous tissue proliferation from the trachea for support. It seems reasonable 
to expect that such a graft should be much less likely to slough or to form strictures. 

PROCEDURE 

AH operations are performed under aseptic conditions. Intravenous sodium pento- 
barbital-positive pressure anesthesia is used. 

With the dog in a supine position an incision is made along the entire course of the 
right 5th rib down to the thoracic cage. The entire 4th rib is now dissected from its 
periosteal bed and retracted out of the operative field until it is used again at the 
time of closure. The superior margin of the 5th rib and the inferior margin of the 3rd 
rib are now freed from their periosteum. Incisions are made along the periosteal beds 
of the 3rd and 5th ribs. This strip of chest wall is now divided anteriorly at the costo- 
chondral junction (Fig. 1 upper right), freeing a long flap composed of intercostal 
muscles, periosteum, neurovascular bundles, and parietal pleura. This graft has an 
excellent blood supply, and bleeding is always noted at its free end. 

Support for the graft is provided by a "U" shaped section of stainless steel wire 
inserted between the external and internal intercostals. The wire is completely covered 
by muscle externally, and by muscle and parietal pleura on its luminal side. This 
support is anchored in place by interrupted silk sutures. The operator is then able to 
mold this wire support into the desired form as the graft is sutured to the defect 
(Fig. 1 lower left). 

By rotating the trachea on the endotracheal tube, all surfaces are made accessible. 
This makes it possible to cover a defect extending about the entire circumference. 
As the graft is sutured in place with interrupted silk sutures, it becomes a muscular 
tube replacing the section of trachea which has been excised (Fig. 1 lower right). It 
is important not to include intercostal vessels in a suture as they enter that portion 
of the pedicle which has been used for the reconstruction of the trachea. This could 
happen as the tube is being completed and the distal end of the graft is being sutured 
to the pedicle at its junction with the trachea. After the defect has been closed, the 
endotracheal tube is withdrawn to a point superior to the graft in order to test for 
leaks. 

The fourth rib now is replaced in its normal position by suturing its costal cartilage 
in place anteriorly. No attempt is made to close the defect caused by the removal 
of the intercostals and parietal pleura. The muscles superficial to the ribs are approxi- 
mated with interrupted silk sutures and the skin is closed with a continuous silk 
suture. The endotracheal tube is removed. 

RESULTS 

In this study, the above technique was used to repair full thickness tracheal defects 
on 10 adult dogs. In 5 animals, complete sections of the trachea 3 centimeters in 



154 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



length, were removed. The remaining 5 dogs had less extensive defects (2 x 3 cm.) 
repaired. 

There were no deaths. Bronchoscopy was performed on 2 dogs from each group 6 
weeks postoperatively. It was difficult to distinguish the luminal side of the graft 




Fig. 1 : Upper left — Orientation sketch of photographs 

(1) Viable Pedicle. (2) Vagus Nerve. (3) Phrenic Nerve. 

(4) Endo — trachial Tube. (5) Superior Vena Cava. (6) Azygos Vein. 



from the surrounding tracheal wall. Two or 3 silk sutures appearing as black dots 
along the line of junction with the trachea could be seen in each case. The graft in 
those cases in which a complete section of the trachea had been removed appeared 
slightly irregular from within, but there was no evidence of stricture formation. 
All dogs were sacrificed 2 months following operation. Examination revealed all 



PEXTON— PEDICLE GRAFT FOR INTRATHORACIC STRUCTURES 155 

grafts to be grown into the substance of the trachea. They were thickened, indurated, 
and composed of muscle surrounded by regenerated bone. The formation of 
bone about the graft seemed to insure its rigidity. It is impossible to say at this time 
whether or not this is an advantage. The tracheal lumens were all smooth, without 
appreciable narrowing in any case. Microscopic examination revealed fibrous tissue 
proliferation beneath and around the borders of the graft. The epithelium which 
covered the luminal side was indistinguishable from the surrounding tracheal 
epithelium. 

SUMMARY 

A method is described for mobilizing a viable pedicle graft from the chest wall 
which has proved useful for replacing excised portions of intrathoracic structures. The 
graft is composed of intercostal muscles, periosteum, neurovascular bundles, and 
parietal pleura. It remains attached to the chest wall posteriorly and retains an ex- 
cellent blood and nerve supply from the neurovascular bundles. This is its chief 
advantage. 

While this method was developed on dogs, it has been used successfully to repair 
a large tracheal defect on a human subject. 

Note: On August 22, 1951 an extensive tracheal defect was repaired on a patient 
at the University Hospital, Baltimore by the method which has been described in 
this report. This case will be published at a later date. 

Experimental use of the graft for the repair of vascular and esophageal defects is 
now being investigated. 

BIBLIOGRAPHY 

1. Hohmeier, F. A.: A New Procedure for Closing Tracheal Defects. Munchen. Med. Wchnschr. 

58: 984, 1911. 

2. Taffel, Max.: The Repair of Tracheal and Bronchial Defects With Free Fascial Grafts. Surgery 

8: 56, 1940. 

3. Nash, R.: Injuries to the Larynx and Trachea. Surg. Gyn. and Obs. 76: 614, 1943. 

4. Grindley, J. H., and Mann, F. C: Surgical Uses of Polythene, An Experimental Study. Arch. 

Surg. 56: 794, 1948. 

5. Hanlon, C. R.: Observations on the Use of Gelatin Sponge in Closure of Experimentally Pro- 

duced Defects of the Bronchus. Surg. Gyn. and Obs. 86: 551, 1948. 

6. Daniel, R.: The Regeneration of Defects of the Trachea and Bronchi. /. Th. Surg. 17: 335, 1948. 

7. Gebauer, P. W. : Plastic Reconstruction of Tuberculous Bronchostenosis with Dermal Grafts. 

J. Th. Surg. 19: 604, 1950. 

8. Gibbon, J. H.: Discussion of a Paper by Daniel. J. Th. Surg. 17: 335, 1948. 



GLOBIN INSULIN WITH ZINC IN DIABETIC OUTPATIENTS* 
SAMUEL T. R. REVELL, JR., M.D. 

It is not the purpose of this report to discuss the pharmacologic actions of the 
various insulin preparations under controlled conditions, but to report our experience 
in using globin insulin with zinc in the control of ambulant outpatients. The patients 
studied have been, with two exceptions, from the Diabetic Clinic, University Hos- 
pital Outpatient Department. It seems pertinent to state that these patients are 
either indigent or are in such a low income group that they are unable to afford 
private medical care. This economic handicap makes strict dietary control very 
difficult. The mental age of this group of patients is distinctly below that of the 
average mental age encountered in private practice. 

The graphs to be presented are selected as representative of the group of about 60 
patients who have been studied during the past 18 months in an attempt to show the 
results obtained in the various types of diabetic patients requiring insulin. In the 
graphs the curves for weight, blood sugar, and insulin dose are plotted with time as 
the abscissas; the curves of glycosuria however are plotted with percentage of the 
total number of specimens examined in the period as abscissas. 

Figure 1. This composite graph represents a 56 year old white male private patient 
with uncomplicated diabetes mellitus, first seen in October 1949, at which time symp- 
toms of weight loss, polydipsia, polyuria had been present for 6 months. The blood 
sugars depicted in this graph were taken 2 hours after his noon meal. The graph 
was selected to show the relative ease of obtaining good control in the uncompli- 
cated diabetic with globin insulin. 

Figure 2. This composite graph depicts the course of a 56 year old white female first 
seen in the diabetic clinic September 9, 1949 because of a palmar abscess of one 
month's duration that had failed to heal following surgical incision and drainage. 
In addition to her diabetes mellitus she was found to have hypertensive cardio- 
vascular disease and arteriosclerotic peripheral vascular disease. Her hyperglycemia 
was well controlled although she continued to show moderate glycosuria. Upon 
substituting Globin Insulin the control of the glycosuria was markedly improved in 
spite of moderately elevated fasting blood sugars. It was necessary to discontinue 
the use of globin insulin because of persistent local reaction about the sites of in- 
jection. This case was selected to show that globin insulin occasionally produces 
reaction about the site of injection. This was the only instance in more than 75 clinic 
patients and all of the private patients treated with globin insulin that exhibited 
this phenomenon. 

Figure 3. This graph depicts the record of a 56 year old white female whose diabetes 
was discovered in 1947 when admitted to the hospital for repair of a post-operative 
hernia. In addition she was found to have latent syphilis, hypertensive cardiovascular 
disease, and obesity, being 50 pounds overweight. In February 1949 insulin therapy 

* From the Department of Medicine, University of Maryland School of Medicine, Baltimore. 
Received for Publication April 4, 1951. 

156 



REVELL—GLOBIN INSULIN WITH ZINC 



157 



was instituted. The 2 middle sections of the graph show the failure to obtain satis- 
factory control with various combinations of insulin. The last section of the graph 
depicts the same patient during 7 weeks of hospitalization when her dietary intake 
was strictly controlled. 



CHS. WM. 56 



A.R.W.F. 56 

C-130 P-80 F-80 

I 2 2 
/ / V 
5 5 5 




^^ 



10 DAYS 8 WKS 



115 
105 
95 
300 
200 
100 


4 + 
2 + 




7 MONTHS 



Fig. 2 



M.R. WE 56 C-180 P-70 F-60 



160- 
140- 




300- 




200- 


> _____-— " 


100- 




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MAY 8, 1950 




240 


230- 
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C-180 P-70 
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230 
220 


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210 


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180- 
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12 months 10 weeks 7 weeks 
Fig. 3 



12 N. 2 RM. 

TIME 

Fig. 3A 



4RM. 6RM. 8PM 



Figure 3 A. This is a 24 hour blood sugar curve on the patient shown in Figure 3. 
This patient represents one of the common findings in private practice and out- 
patients, namely, obesity and failure to follow dietary instructions. This particular 
patient had in addition, the complicating factors of latent syphilis and hypertensive 
cardiovascular disease. 



158 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



Figure 4. This graph depicts the course of a 46 year old colored female whose 
diabetes was first discovered in 1943 at which time she was 25 pounds overweight. 
For 4 years her diabetes was satisfactorily controlled on small doses of protamine 
zinc insulin. Following a hysterectomy and appendectomy her insulin requirements 
steadily rose as did her weight, with poor control of her diabetes. In March 1950 her 
diet was reduced and her insulin changed to globin. The patient continued to exceed 
her diet, but the glycosuria markedly improved in spite of the fact that the fasting 
blood sugar determinations remained elevated. 

Figure 5. This graph depicts the course of a 47 year old colored female whose dia- 
betes was discovered in January 1944. At that time she was 70 pounds overweight. 
From January 1944 until August 1949 the patient continued to exceed her diet and 
steadily gained weight with poor control of her diabetes. In August of 1949 the 
patient was placed on a 2 to 1 insulin mixture, and during the 8 week period of ob- 



HW C.F 46 



C-200 P-75 F-90 




Fig. 4 



servation her diabetes was satisfactorily controlled. The same patient on a slightly 
reduced caloric intake, had globin insulin substituted for the 2 to 1 mixture. As seen 
in the graph there was no appreciable change in the blood sugar levels but there was 
continued improvement in the amount of glycosuria. As is obvious from her weight 
graph, she did not follow her reducing diet. The patients depicted in Figures 4 and 
5 represent a common type of individual seen in diabetic outpatient work, namely, 
the uncomplicated, obese, insulin-resistant diabetic. 

Figure 6. This graph depicts the course of a 27 year old colored female, a known 
diabetic of 12 years duration. She was first seen in the Diabetic Clinic in the summer 
of 1947 at which time she was 60 pounds overweight and 7 months pregnant. The 
obstetric history revealed 2 previous pregnancies which had terminated in still- 
births. She had never followed a diet but had taken regular insulin, 15 units three 
times daily. During the remainder of this pregnancy she was maintained on regular 
insulin twice daily and was delivered of a live baby by Caesarian section in August 
1947. For the 6 months following delivery the patient totally disregarded her diet 



REVELL—GLOBIN INSULIN WITH ZINC 



159 



and stopped taking insulin. She returned to the clinic in March 1948 at which time 
she was started on protamine zinc insulin. In July of 1948 she again became pregnant 
and again did not follow her diet. Her insulin doses were progressively increased 
without good control, but in spite of this she was delivered by elective section of a 
live baby in February 1949. The last section of the graph shows the same patient on 
globin zinc insulin and a 25 calorie-deficit diet which she failed to follow. After 6 
weeks of globin zinc insulin alone, protamine zinc insulin was added because of the 
persistently high fasting blood sugar and moderate glycosuria. This case was selected 
to show the combined problems of the insulin resistant, obese diabetic, the effect of 
diabetes on pregnancy, and lastly, the possibility of supplementing globin insulin 
with protamine zinc insulin. 

Figure 7 . This graph depicts the course of a 67 year old white male who was first 
seen in the Diabetic Clinic in December 1940 at which time he was 100 pounds over- 




C-ISO P 60 F-50 

// 2/ 2 / 

5 5 5 



J.B.T. W.M 67 




Hi 



C-140 P-60F-II0 



X 2«h 

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* 20O-: 

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260 
240 
220 
200 

180 



200 
100 



Fig. 6 



Fig. 7 



weight. At that time he had diabetic peripheral neuritis manifested by a wrist drop 
and a foot drop. For 5 years diet was adequate to control his glycosuria and hyper- 
glycemia. In 1945 he began to experience hyperglycemia and glycosuria with some 
weight loss. At that time he was started on protamine zinc insulin. In February 1950 
he was placed on a 750 calorie-deficit diet and the insulin was changed to globin. This 
failed to control his glycosuria. During the last 3 weeks of observation the globin 
insulin was given in divided doses with resulting satisfactory control of the hyper- 
glycemia and absence of the glycosuria. This case was selected as an instance of an 
insulin resistant, obese diabetic that was complicated by a diabetic peripheral neu- 
ritis. 

Figure 8. This graph depicts the course of a 52 year old white female first seen in 
the Diabetic Clinic in 1949 at which time she was 90 pounds overweight. She had 
been a known diabetic for 10 years having been initially discovered in 1939 when 
admitted to another hospital in coma. During the subsequent 10 years she was 
admitted, on 8 occasions, to several Baltimore hospitals in coma. During this interval 



160 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



bilateral lumbar sympathectomies had been performed because of peripheral vascular 
disease. In March 1949 she suffered a cerebral vascular accident. When first seen in 
the Diabetic Clinic she was placed on a salt-free reducing diet and started on globin 
insulin. She failed to follow her diet and in spite of steadily increasing her dose of 
insulin she was poorly controlled. In April 1950 she was admitted to the University 
Hospital for control of her diabetes and ligation of bilateral varicose veins. The last 
section of the graph shows her hospital course under controlled dietary conditions. 



MR WF 52 



C-135 P-55 F-40 SALT FREE 



C-II5 P-40 F-35 SALT FREE 




HOSPITAL DAYS 



Fig. 8 







M.R. 










MAY 5, 1950 


BLOOD SUGAR CURVE 






6L0BIN INSULIN 60 


UNITS 






C-M5 P-40 


F-35 


'5 '5 '5 












170- 

188= 

M0- 
130- 
120- 
110- 

ioo— 




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U 
N 
C 

A H 


S 
U 
P 
P 

E 
R 








i i i i 


I l 


1 1 1 1 1 M 



8 10 12 2 4 6 7 9 II 

Fig. 8A 



Figure 8 A. This depicts a 24 hour blood sugar curve on the same patient shown in 
Figure 8. This case was selected to demonstrate the excellent control of severe diabetes 
when all factors can be controlled. It shows in addition, the safety factor of globin 
insulin in a severe diabetic outpatient who refused to follow instructions even though 
satisfactory control is not maintained. 

Figure 9. This graph depicts the course of a 38 year old colored male first seen in 
the Diabetic Clinic in 1946 in mild acidosis. He was given diet instructions and taught 
the self-administration of insulin and returned to his family physician. The patient 



REV ELL— GLOB IN INSULIN WITH ZINC 



161 



was returned to the Diabetic Clinic in August 1948 out of control and suffering from a 
generalized pydodermia. His insulin requirements rapidly rose and control remained 
very unsatisfactory with hyperglycemia and marked glycosuria. In September 1949 
this patient was placed on globin insulin and protamine zinc insulin. His control 
remained completely unsatisfactory because of numerous hypoglycemic reactions. 
At the end of this period of observation he developed lobar pneumonia and entered 



D.H CM. 37 





CI75 P80F NO 


160 - 
140- 
120- 
400^ 




300- 




200- 


-A 


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140 -: 
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80- 
60- 


;H 



C 250 P dO F 90 C ; 

I, 2, 2, 




7 MONTHS 5 WKS. 



Fig. 9 



C-200 P-120 F-IIO 



C-200 P-120 F-IIO 
'/ 2/ 2, 




Fig. 10 



the hospital in severe acidosis. In the last section of the graph insulin was adminis- 
tered in divided doses of globin. During this period his control was completely satis- 
factory with absence of insulin reactions, satisfactory blood sugars, and minimum 
glycosuria. This case and the one to follow were selected to depict one of the most 
difficult problems in the management of diabetic patients, namely, the juvenile or 
"brittle" diabetic. The degree of control accomplished by 2 doses of globin insulin 
in these patients was far greater than that obtained by any other method. 
Figure 10. This graph depicts the course of a 36 year old white male private patient 



162 BULLETIN OF THE SCHOOL OF MEDICI XE, U. OF MD. 

who was first seen in February 1950 in mild acidosis as the result of an upper respira- 
tory infection. The patient had been a known diabetic for 19 years. He had been 
well controlled by diet and small doses of protamine zinc insulin until 19-18 when he 
was admitted to another hospital in coma. He was readmitted to the same hospital 
6 months later in moderately severe acidosis resulting from a streptococcal throat 
infection. During the subsequent 2 years he had been maintained on a diet and was 
taking protamine zinc insulin 32 units, and crystalline zinc insulin 10 units. On this 
regime he had experienced hypoglycemic reactions averaging at least 3 each week. 
Because of his past history an attempt was made to control this patient on globin 
insulin in a single dose, but he continued to exhibit hypoglycemic reactions although 
not so frequently as previously. The second portion of this graph shows the same 
patient on globin insulin in divided doses with additional improvement but still some 
hypoglycemic reactions. On May 26, 1950 a diurnal blood sugar curve was performed. 
This is plotted in the upper right hand section of the graph. Following demonstration 
of the hypoglycemia at 5 P.M. the patient was given a cup of milk and crackers in 
the mid-afternoon with complete elimination of insulin reactions. 

Subsequent to these observations this patient developed severe diabetic retinopathy 
and nephropathy, probably of the intracapillary glomerulosclerosis type. 

SUMMARY 

An attempt has been made to present the results obtained in ambulant diabetic 
patients of varying type and severity using globin insulin. The cases selected are 
believed to be representative. 

CONCLUSIONS 

1. Globin insulin has been found to be an effective form of substitution therapy in 
the diabetic patient requiring a relatively small dose of insulin for satisfactory control. 

2. Globin insulin has been found to exhibit a moderately wide range of safety in 
diabetic patients whose failure to follow instructions had led to repeated instances of 
diabetic coma. 

3. Globin insulin in divided doses has been found to be an extremely efficient tool 
in the successful management of "brittle" diabetics. 

Burroughs Wellcome and Company (U. S. A.) Inc. generously supplied the globin insulin with 
zinc for this study. 



CONCERNING VALUES IN MEDICLNE*f 

JACOB E. FINESINGER, M.A., M.D. 

This evening marks a special event to you, members of the class of 1950, to your 
families, to your friends, and to your teachers as well. It marks the completion of a. 
phase of years of preparation and study. To many it is the culmination of years of 
saving and denial. Your efforts and those of your families have been successful and 
have resulted in your being welcomed into the fellowship of physicians. You, and your 
families as well, are to be congratulated on this achievement. Your teachers have 
now truly become your colleagues. They, too, I am sure can justly feel the satisfaction 
of having played a part in guiding you to the status of physician with all the privileges 
and responsibilities that go with this status. I am merely spokesman for many who 
hold high hopes for you in pursuit of your chosen career. 

You are taking your part among a group of men and women who have given sup- 
port and relief to their fellow man. These men and women represent links in an 
age-old chain going back into antiquity. Theirs is a tradition of effort and achieve- 
ment dedicated to the welfare of man. This desire to lessen suffering has been the 
consistent aim in the lives of physicians, leading all the long way from medicine man 
with his magic rites to the modern doctor with his methods of diagnosis, therapy and 
prevention. In our days the profession of medicine represents a unique opportunity for 
work and satisfaction. Above all other professions, perhaps, it makes use of scientific 
method in the service of human and personal goals — the practice of the healing arts. 
Through his daily work the doctor brings the results of his knowledge, skill, and in- 
vestigations to the needs and the sufferings of his patient. His is not a life of pure 
scholarship in quiet halls of comtemplation. He works with life itself. At no point can 
he get away from the need to consider and to help his patients — and yet he must do 
this with imperfect tools and incomplete information. He must draw from the best 
that is available and direct it to serve his goals. He must be objective and sound, and 
at the same time resourceful and patient. He must have the rare qualities of adapting 
scientific generalizations to the service of the individual patient. His task is a trying 
one. It requires an unusual combination of human traits. 

For this evening's talk I have selected the topic of values in medicine. By values 
we mean certain preferences which are important to us as doctors and as civilized 
human beings. Some of these preferences we state openly. Others are implicit in our 
behavior. As a modern civilized human being, I may prefer peace to war, and a gen- 
eral increase of human welfare and happiness to the guarding of special privileges. 
These preferences will be shown in much of my behavior, in various ways. I may 
merely talk about them. I may have a pleasureable feeling when I think about them, 
or they may influence many of my actions. I may prefer the free expansion of knowl- 
edge to the limitations imposed by authoritarian decree. I may prefer freedom of 
thought and speech to suppression. In choosing the profession of medicine, you and I 

* From the Department of Psychiatry, University of Maryland School of Medicine. Baltimore. 
f Read at the Pre-Commencement Exercises, University of Maryland, School of Medicine, June 
8, 1950. 

163 



164 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

both show evidence of a preference for sustaining human life, for health, for growth 
toward full maturity — otherwise, it would be difficult to understand why we have 
chosen to be physicians. 

In the course of our busy lives as students, teachers and doctors, we find little time 
for the consideration of our values. They seem so obvious. As we rightfully become 
concerned with our job — with the cure of patients — we tend to pay little attention to 
the values and the motivation which make it important for us to cure and to help 
patients. Traditionally, the doctor's values have included broad concepts, such as the 
preservation of life at a high level of health and the spread of medical care. These 
broad general values are familiar to and accepted by every physician, and for that 
matter by every civilized man. Yet we feel that it is pertinent to ask, how helpful are 
these general values in our lives as doctors working with patients? Values are not too 
useful if they remain merely as thoughts or ideas which give us good feelings as we 
state them or hear about them. We would suggest they are meaningful to us in our 
work only insofar as they are translated into specific attitudes and concrete actions 
geared to help us in the situations which we meet in the practice of medicine. This 
implies in essence breaking down these broad concepts in terms of our every day be- 
havior. In doing so we begin to deal with more specific actions directed more closely 
to our work. We should like to check and evaluate these actions as to their effective- 
ness. Do these values tell us what to do? or what to say? Do they direct our behavior, 
and if so, is this behavior worth while? The idea of alleviating human suffering is little 
more than a slogan until we find and apply techniques to relieve pain in the individual 
patient. In other words we should question the usefulness of the general principle as 
such. We would feel that values are important as they lead us to operational defini- 
tions and procedures. 

Most of the decisions which you young physicians are about to make will be based 
on the relative importance which you attach to certain values. These decisions are not 
simple. In the first place each of us wants to be a good doctor. This itself involves a 
very crucial judgment value — namely, what is a good doctor? In order to answer this 
question it is necessary to define the word "good" in respect to specific situations. 
What does the good doctor do in respect to his relation to his patients or to his work? 
How does the good doctor act in respect to the body of medical knowledge and its 
growth, or to his colleagues and students and to his community? In each of these 
instances which deals with the doctors' behavior, it would also be necessary to work 
out ways of describing and assessing the behavior. Each of these questions involves 
judgment of objective values, by which we mean values that can be measured in terms 
of behavior. At this stage of your careers you are concerned with training. What con- 
stitutes good training? Later on you may be faced with decisions involved in the 
practice of medicine. You may be concerned with your position in the community, 
your financial status, your hospital connections, your relationships with your patients. 
Decisions in all of these matters involve the relative hierarchy of certain values — that 
is stressing the importance of certain values above others. 

Many of us are aware of some of the values behind our motives, which in turn 
affect our behavior. To others this awareness seems not so necessary. You may be 
wondering this very minute — how important can all this be to me, who have already 



FIN ESI NGER— VALUES IN MEDICINE 165 

made some major decisions in life. Is it really necessary for me to be concerned with 
these never-ending problems? I want to be an internist and after several years of 
training, I can reasonably look forward to a successful and useful career as a doctor. 
I need not concern myself too much with these matters. They can be left to hair- 
splitting metaphysicians whom we have left far behind, mummified in college courses. 
Usually the values underlying our decisions are not apparent. They are implicit. How- 
ever, the day does not go by in the life of the physician when he is not called upon to 
behave in certain ways: — should he tell the patient the truth about his cancer? Should 
he refuse to give the demanding patient sedatives at the risk of losing him to another 
doctor who may not be so scrupulous? Should he make promises to the patient which 
he knows he cannot carry out? In such problems the doctor cannot avoid considering 
his values. In situations of this kind, when he does not quite know what to do, the 
doctor is forced to act, whether or not he is aware of the values involved. If he is 
naive, or unaware of the values involved, and if his behavior appears consistent, he is 
likely to be acting in accordance with values derived from one of two possible 
sources. He is either applying so-called common sense to the situation, or he is taking 
over ready-made values offered to him, usually emanating from some other institu- 
tion or discipline. In either case his performance under these circumstances may not 
be in line with the most effective medical practice. 

Common sense as a sound basis for behavior can be delusory. This may sound sur- 
prising, perhaps even paradoxical. Common sense would tell us, as it told our an- 
cestors, that the sun moves across the sky. It is obvious — you can see it. Yet this is 
not the case, as we know from well-established facts. Common sense reasoning would 
dictate that cancer patients should preferably be spared the dread knowledge of their 
diagnosis. Yet recent study indicates that most cancer patients make a more satis- 
factory adjustment and utilize their capacities better when their diagnosis has been 
discussed in detail with them by their doctor. Common sense would tell us that we 
could control our behavior if we only wanted to. Yet recent work in my own specialty 
has shown that symptoms and much of the behavior of patients — and doctors too, 
I suppose — may be determined by unconscious factors — factors that we are not aware 
of. Inferences from common sense can be frequently misleading. As doctors we want 
to be on our guard against their indiscriminate use. 

We must also be careful in completely accepting the judgment values which come 
from other institutions. These values may be based on outmoded information. They 
may derive from rigid groups or institutions established by society for purposes which 
in many ways differ from and are at variance with those of the scientifically oriented 
doctor. 

We believe that the doctor's behavior is based in a great measure on judgment 
values — whether or not he is aware of these values. It would seem that the doctor who 
is aware of the values underlying his behavior, is in a position to operate more effec- 
tively and realistically in working with his patients. Awareness itself may alter the 
behavior of the doctor. It is possible that he will then understand more completely 
and as a result become better equipped to deal satisfactorily with his patients as 
individuals — and with their physical, mental, and social adjustments. Certainly our 
decisions will be more meaningful if we can be aware of the particular value or series 



166 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 






of values involved in these decisions, whether they be ethical, aesthetic, personal, or 
social. 

There are obviously a host of value judgments which come to the fore whenever 
any matter of preference is considered. Some of the doctor's values are no longer con- 
troversial — though they were fiercely fought over in the past. Today, for example, 
we all accept the use of asepsis, vaccination, and some of the contributions of epi- 
demiology. Once scientifically established, these have now become an integral part 
of the doctor's system of values, and he behaves accordingly. As more and more 
scientific facts are discovered, the doctor's values change, keeping pace with this 
expanding knowledge. There still remain burning issues which have not been settled 
because knowledge is incomplete or inaccurate. Further, there remains the problem 
of what should be the doctor's attitude toward questions that involve insufficient 
knowledge, controversial questions, in medical practice, medical service, or other 
matters involving human and social problems. 

I do not propose to give answers to the many questions I have already raised. I 
should merely like to suggest that these issues are important and have a practical 
bearing upon our work. More recently they have been the focus of discussion by 
many scientists and philosophers. There is a growing body of opinion that the problem 
of values cannot be treated haphazardly. It needs the joint efforts of people working 
in many disciplines. 

It is true that many of the traditional problems with which metaphysicians have 
been concerned are off in an orbit far removed from the hurly-burly and pressures 
of the doctor's world. Within our generation there has, however, risen a school of 
philosophers deriving from British Empiricism and from iVmerican Pragmatism, who 
have taken to heart the problems of the doctor and the scientist in his need for clarity. 
The work of these empiricists or positivists — Ernst Mach, Rudolph Carnap, Philipp 
Frank — has been of inestimable value to many scientists. They have pointed out 
that the traditionally idealistic philosophers starting from Plato and Aristotle have 
put their statements in such a way that they cannot be checked, and are not subject 
to verification by direct observation and by other tools of the scientist. The meta- 
physicians have been helpful in developing systems of logic and clear thinking. They 
have been satisfied, however, to apply logic toward the solution of problems which 
can never be solved by recourse to objective fact. Furthermore, they have made 
broad use of arguments from analogy, which can be misleading. This is in marked 
contrast to the orientation of the positivist who insists that we set up problems in a 
form which can be proved or disproved by observation and measurement. One of the 
striking values of this approach is that it allows us to predict and ultimately to 
utilize and control the phenomena in the world about us — whether these phenomena 
are in the realm of the physicist, the chemist, the physician or even the sociologist 
and economist. 

I, myself, am obviously no professional philosopher, yet I have been impressed 
as a physician with the need of a clearer understanding of these involved matters, 
especially as they bear upon our decisions and practical work. It would seem worth 
while in our busy lives to take stock of our own personal preferences or values and 
those of the members of our own profession. Such stock taking and fundamental 



FINESINGER— VALUES IN MEDICINE 167 

questioning need not be reserved for rare academic occasions such as this. The doc- 
tor's job also involves the constant questioning of his behavior in terms of its effec- 
tiveness in the light of our increasing knowledge. This questioning attitude, the re- 
fusal to take anything for granted, is basic in the workaday life of the scientist. 

This brings us to the question of how can we find out what values determine the 
doctor's behavior? Is there any operational approach which we can use to get a 
meaningful answer? Can we pick up any leads by watching the doctor's behavior? 
If one wants to determine values in medicine there are at least two obviously avail- 
able approaches. The first is to ask the practitioners of medicine for statements re- 
garding thsir motivation or for statements regarding their ethical values. Why do 
you want to cure patients? Why are you against or in favor of socialized medicine? 
These replies could be studied, but here we would be dealing with expressions of 
conscious ideas. We might guess that the collection of such material would show 
considerable variation and marked difference of opinion. Material of this kind would 
tell us the verbalization, of doctors, but might give no clue as to whether such values 
were actually carried out in practice. Who knows, we might even find a considerable 
discrepancy between these verbalized statements and the actual operational be- 
havior. Further, such replies would not consider the unconscious factors operating 
in the choice of values. 

Another and probably more meaningful way would be to observe the behavior of 
doctors and from their behavior to draw the appropriate inferences. As one observes 
doctors in action, their attempts at saving and maintaining life, their efforts at re- 
lieving pain and suffering, their attempts at careful observation and the use of scien- 
tific methodology — one is forced to infer that physicians have reasonably consistent 
values in reference to their work. These values might be briefly summarized in two 
categories: The first dealing with purposes and goals — the saving of human life, the 
amelioration and prevention of pain and suffering, and the broadest dissemination 
of medical treatment to the population at large. The second category is concerned 
with the method of achieving these goals — namely, the use of an approach and of 
methods which involve the description of the phenomena, the establishment of cate- 
gories, the development of hypotheses and their validation through observation and 
experiment. These values have much in common with those of the scientist. By 
virtue of the complex nature of the doctor's work — of the various roles he has in the 
life as well as in the treatment of his patients — he, of necessity, becomes more aware 
of the human and social values. 

It is difficult to take issue with such an impressive and high sounding list of values. 
Why then, can we not consider the selection of values in medicine a closed matter 
and turn our attention with relief to specific workaday problems, as doctors and 
medical specialists? 

That these are not closed matters can be seen from a more careful scrutiny of the 
doctor's behavior. At the same time that we are concerned with alleviating suffering, 
we are also concerned with earning a living, which to most doctors means practice 
and an office, and overhead, and the manipulations necessary in developing and 
holding on to a practice. Physicians in academic life have their own mundane prob- 
lems too, connected with competition, advancement and the creation of oppor- 



168 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

tunities for work. Often it is difficult to apportion one's time between study and more 
practice. There will be decisions to be made involving certain therapeutic procedures 
which may be lucrative but of uncertain therapeutic validity. The doctor who is 
concerned also with investigation will have to make decisions involving procedures 
which may advance our knowledge at the expense of some inconvenience or even 
discomfort to patients. The dissemination of medical care to the population at large — 
which is a broad general value readily verbalized — may in practice bring up certain 
difficulties. A system that will bring comprehensive medical care to the masses of 
people who need it may mean that many individual doctors will earn less money. 
Such a system might also involve the danger of a leveling off from high standards of 
individualized treatment of patients. This, too, is undesirable and runs counter to 
our general values. We might digress to point out that in this current highly contro- 
versial matter, it is crucial to state the issues in operational terms. We must state 
the question — how can we arrive at a workable solution? What would we have to 
do to make a particular system work? It is difficult to be cool and objective in setting 
up the appropriate studies and to evaluate them objectively. Yet we all agree that 
some change is necessary. Maybe the first operational step is to examine existing 
systems from a constructive point of view, to eliminate the bad features, and to pre- 
serve and amplify those that are useful. It is so easy — yet so unproductive — to state 
and restate high sounding slogans — which represent extreme non-operational points 
of view. 

As doctors we do not live in a social vacuum. We are human beings who are re- 
sponding to economic and social pressures as well as to the tenets of Hippocrates. 
In other words we are dealing with competing values. Conflicts ensue, and the de- 
cisions become perplexing and difficult. The honored and high sounding broad general 
values, to which we all do service, resolve themselves into myriads of decisions which 
require thought, and which above all must weather the test of experience. 

In dealing with conflicting values, it may be wise to take stock and decide as to 
the hierarchy — which things come first. It may be necessary to qualify our values, 
and restate them more precisely taking into consideration how they actually work 
out. We can distinguish and separate out the effective elements — those which in- 
fluence our actions from the verbal elements — those which do not influence our ac- 
tions. If I may repeat, in instances involving conflicting values, the operational ap- 
proach would be to reconsider the value or values involved to separate and retain 
the part which as meaningful discourse leads to action — from the part which as 
empty talk leads to further abstraction and as such can be dispensed with. To quote 
a statement of Charles Saunders Pierce dealing with belief as cited by Frank — "The 
essence of belief is the establishment of habit ; and different beliefs are distinguished 
by the different modes of action to which they give rise. If beliefs do not differ in 
this respect, then no mere differences in the manner of consciousness of them can 
make them different beliefs". 

The values of the doctor are not static. This can be seen from a perusal of the his- 
tory of medical practice. Values are constantly changing. We can see how the results 
of scientific knowledge are incorporated into our system of values. The important 
discoveries in medicine during the past century offer cogent illustrations. It is hardly 



FI N ESI NGER— VALUES IN MEDICINE 169 

possible for the modern surgeon to witness violations of the principle of asepsis with- 
out reacting violently. The principle of asepsis, which was the result of scientific dis- 
covery, has so crept into our values, that any breach of technique brings about an 
emotional reaction in the well-trained doctor. It is contrary to our values as doctors 
to tolerate anything which results in the spread of communicable disease. We are 
gradually reaching the state of development which will not tolerate the spread of 
outmoded ideas about personality and human behavior. 

As doctors we are accustomed to operating in a world of changing values, and it is, 
I believe, realistic to recognize this fact. This does not imply that our values are ac- 
tually whimsical or that they respond by a change in direction for each new experi- 
ment. To be sure there are instances which accepted values seem to swing about in a 
circle responding to still incomplete information or incorrect inference. An example 
of this from pediatrics is the shift in attitudes towards feeding schedules. Of im- 
portance to us as doctors is an understanding of the factors that bring about this 
change in our accepted values. These factors may come from various sources. I would 
consider that those changes which come as pressures from political institutions, or 
other non-scientific organizations or cults, seldom stand up to the rigorous test of 
experience. The other and far more lasting changes in our medical values seem to 
come from the convergence of evidence derived from new findings added to well es- 
tablished knowledge. The fact that values change need not disturb us. A reasonable 
attitude is to consider our medical values as satisfactory guides to action so long as 
they represent inferences from the best available knowledge and experience. We 
must, however, allow ourselves sufficient flexibility to consider newer values on the 
merits of newer evidence and broader experience. Perhaps this is a workable rule 
when applied not only to the values of the doctor, but to those many other values 
as well that affect our behavior in general. 

As to the origin of these ethical or social values, it may be that they have come 
from a variety of sources, each interacting with the other. Some would contend that 
our values for the good life are ultimate and inflexible imperatives that come to us 
from religious leaders and philosophers. On the other hand one can observe that not 
all the values stated by religious and ethical leaders have remained. There seems to 
be a process of selection going on which discards certain values and supports others. 
Hence, there is another point of view, which happens to be closer to my way of think- 
ing. This point of view considers that our ethical values have gone through an evolu- 
tion in which trial and error has played a significant part. Our current values would 
then be the resultant of a process closely related to our social experiences. As civiliza- 
tion advances — even though the advance is slow and disheartening at times and by 
no means uniform all over the world — many experiences converge to make people 
discard outmoded values and accept new ones. The values associated with the state- 
ments: "An eye for an eye. A tooth for a tooth.", prove less useful to society and are 
supplanted by other values, which operate so as to favor the growth of the individual 
towards full maturity in a democratic society. 

I find it hard to leave the questions of the values of the doctor without some con- 
cern as to his values as a citizen. The doctor is not only a trained professional worker 
in the community. He is a citizen as well and as such has a certain status and role 



170 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MB. 

with the inherent privileges and responsibilities. It is not too important to consider 
whether he is a doctor first or a citizen first. What is important is the recognition 
that a certain harmony of both roles is needed for effective living. There are many who 
believe that the problems of the choice of values is not the concern of the doctor. 
His job is merely to cure people, to relieve their suffering. Once this is accomplished, 
his job is completed. The same idea is often held in appraising the role of the scien- 
tist. It is alleged that the scientists' job is merely to determine how things work 
whereas the quest for values is beyond his legitimate sphere. This implies that the 
doctor and scientist must obtain their values ready-made for them by others. To 
my way of thinking, this is a debatable issue. I consider the selection of values too 
closely tied up with our goals and even our procedures, as doctors. Values might 
come to us ready-made — their origin and source is not too important, but we must 
be free to assess, to qualify, and to modify them in light of our own individual or 
collective experience. 

I believe that our job as physicians and citizens does not end with the cure of the 
patient. We cannot avoid being concerned with: Cure for what? In other words what 
kind of a world are we going to send our patients back to? On two counts we can 
consider this a legitimate concern. In the first place it may well be that many of the 
factors that cause exacerbation and persistence of illness find their home in the social 
situation. In the second place we may be reluctant to invest our time and efforts in 
work which is likely to be undone by others at the mere stroke of a pen. It would 
seem highly inefficient, to say the least, to cure people and have their lives snuffed 
out by the atom bomb or by the other horrors of modern warfare. We cannot expect 
to achieve our values as doctors, if we remain indifferent to the factors operating in 
social and economic spheres. Here, too, we would hope that the application of op- 
erational criteria will be productive in the gradual solution of these human and social 
problems. 

The job of the doctor has much in common with that of the scientist. The orienta- 
tion is the same; the methods are the same, and the values are the same. They both 
recognize that we live in a changing world — our methods, our information and even 
our values change. By virtue of the special therapeutic relation between the doctor 
and the patient, the doctor obviously must place more emphasis on a greater under- 
standing of human values. The awareness of these factors in our behavior as doctors 
makes us more realistic in our work, more considerate in the selection of our goals, 
and more rational in our ideals. We do not consider any issue a closed issue and re- 
fuse to take anything for granted. We wish to make our incomplete knowledge more 
complete. This point of view leads to the idea and hope of unlimited progress in 
thought and life. The very fact that we this evening are discussing matters which 
involve new plans and new work indicates to me that there is a future for us, with 
many places to go. 

As young physicians, ready for the next step in your careers, yours is the oppor- 
tunity of working together along these lines. We cannot see how this point of view 
and its correlaries can fail to increase the welfare of our patients. 



TENDON FORMS FOR USE IN THE TREATMENT OF 
SEVERED TENDONS*! 

ERWIN R. JENNINGS, M.D., GEORGE H. YEAGER, M.D., and 
OTTO C. BRANTIGAN, M.D. 

Methods for repair of severed tendons have long been of interest to the surgeon. 
Because results in tendon repair are frequently unsatisfactory, a practical method of 
correlating and tabulating techniques with end function is being attempted. It is 
believed that analytical comparison of techniques will ultimately lead to the develop- 
ment and acceptance of a method productive of more satisfactory results. 

In order to tabulate techniques employed with end results of tendon repair, a 
standard form or patient's record is being used at the University Hospital. For pur- 
poses of further development and comparison, several techniques and routines have 
been established. 

The tendon form, as well as the basic principles observed, are herewith presented. 

TENDON FORM 

This form is designed for the purpose of easily demonstrating the extent of the lesion 
and the method of repair. The diagrams purposely avoid lengthy descriptions, the 
intent being to precisely indicate the tendon or tendons involved. By correlating the 
anterior-posterior with the cross-sectional views, the superficial wound can be drawn 
in and the tendons involved can be designated by circling the related area. Concomi- 
tant injury of nerve and bone can be listed in the designated space and thus insure a 
more thorough correlation with the ultimate outcome. 

Suggestions for follow-up data have been placed on the back of the standard ten- 
don form. This assures complete information from the time of injury to discharge. 

Posted routines at this clinic are as follows: 

(a) ACCIDENT ROOM 

After determining the extent of the lesion, the wound is flushed with 1000 cc. of 
sterile saline, and a sterile dressing applied. Tetanus toxoid or antitoxin is given as 
indicated. 

(b) OPERATING ROOM 

1. All tendons are sutured in the operating room under aseptic conditions by a 
surgeon specifically assigned to this problem. 

2. In general, tendons are not sutured if the wound is grossly contaminated. This 
statement is flexible and is left to the discretion of the operator. Free ends of nerves 
and tendons may be identified with non-absorbable sutures, providing extensive 
dissection is not required. 

3. In the operating room, the wound is washed gently with sterile green soap and 
sterile water. Wound edges are cleansed with ether, alcohol and tincture of merthio- 
late. 

* From the Department of Surgery, University of Maryland School of Medicine and the Uni- 
versity Hospital, Blatimore, Maryland, 
t Received for publication May 20, 1951. 

171 



172 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



TENDON FORM 



Name 

Address 

Duration of Injury 

Right 

Bones 

Vessels 

Nerves 

Tendons 



Age 

ATS 
Left 



Sex Race 

How Injured 
Chemotherapy 



Date 



No. 



-FLEXOR CARPI RADIALIS- 
-MEDIAN NERVE- 

-PALMARIS LONGUS 

-FLEXOR DIGITORUM SUBUMAS 

-ULNAR NERVE- - 

-FLEXOR CARPI ULNARIS--- 




-EXT. CARPI ULNARIS-- 

■—EXT. DIGITI OUINTI 

EXT. DIGITORUM COMMUNIS - 
-EXT. INDICIS PROPRIUS ■ 
EXT. POLLICIS LONGUS- 



Suture Material 

Method of Suture 

Length of Time of Immobilization 

Report to Residents Clinic 

Signed 



JENNINGS ET A L— TENDON FORMS FOR SEVERED TENDONS 



173 



4. Fine steel wire is used as suture material. 

5. Suture technique is the responsibility of the surgeon and is recorded by diagram. 

6. Hemostasis is aided by the use of a tourniquet. 

7. If both the Flexor Digitorium Sublimis and Profundus are severed within the 
flexor tendon sheath, only the Flexor Digitorium Profundus is sutured. The Flexor 
Digitorium Sublimis may be removed for a distance of one centimeter proximally and 
distally. 

8. Antibiotics or chemotherapeutic agents, according to the preference of the 
surgeon, are used for a minimum of four days. 

9. All affected tendons are immobilized for three weeks. Immobilization in posi- 
tions of extreme flexion or extension are avoided. 

10. A tendon form must be completed for every patient. 



FOLLOW-UP SHEET 



Disp. No.. 



Week 1 
Week 2 
Week 3 
Week 4 
Week 6 
Week 8 
6 Months 
1 Year 



Results 



Poor 



Fair 



Good 



Excellent 



Occupational Therapy Yes No 



Limitation (%) and Deformity at discharge 



SUMMARY 

1. As a result of the unsatisfactry results in the treatment of severed tendons, a 
need is seen for the accurate tabulation of techniques. It is believed that by accurate 
analysis of records and follow-up data, more satisfactory procedures will eventually 
emerge. 

2. A tendon form is presented which is designed to facilitate the precise recording 
of methods employed. This form also serves as a means of tabulating follow-up data. 



ISLET CELL TUMOR OF THE PANCREAS— Report of a Case Originally 
Diagnosed as Post-Partum Psychosis*! 

S. EDWIN MULLER, M.D. and JOHN A. SPITTELL, Jr., M.D. 

Patients with hypoglycemia may present symptoms referable to disturbances of 
the central nervous system, autonomic nervous system, the gastrointestinal tract, 
or the cradiovascular system (1). Many authors in the past have noted symptoms of 
mental or nervous disturbances in hypoglycemia. Incorrect diagnoses such as epi- 
lepsy (2), brain tumor (3), chronic alcoholism (4), encephalitis, neuro-circulatory 
asthenia, cardiac neuroses, angina pectoris, peptic ulcer, and mental disturbance 
requiring committment to institutions in the past have been made on patients in 
hypoglycemia caused by islet cell tumors of the pancreas (5). Whipple and Frantz 
state that the most common erroneous diagnoses are epilepsy and alcoholism (6). 

The occurrence of post-partum hypoglycemic attack is noted by Campbell et 
al. (7). Also, the relationship of hypoglycemic attacks, as a result of islet cell tumors, 
to the menstrual cycle has been mentioned by White and Gildea (8), and Campbell 
(7), and the possible effect of estrogens on glucose metabolism has been discussed. 

CASE REPORT 

A 32 year old white female was admitted to Mercy Hospital on August 6, 1950, with a chief 
complaint of weak spells during the past seven months. 

On January 2, 1950, she gave birth to a full term, living child weighing 7 pounds 12 ounces. The 
patient's pregnancy was remarkable only insofar as she had "heartburn" from the fifth to the ninth 
month. Labor was essentially uncomplicated, and her post-partum course was normal. She was 
discharged from the hospital with her baby on January 7, 1950. The patient stated that her post- 
partum course at home was marked by extreme weakness, causing difficulty on arising in the morn- 
ing. During her first week at home, her husband called her attention to several peculiar things she 
was doing. On January 16, 1950, 14 days post-partum, she awoke in the morning, "wringing wet 
with perspiration", and feeling extremely weak. The same occurred on the following morning, but 
gradually wore off as the day proceeded. On January 18, 1950, she arose despite her feeling of ex- 
treme weakness. She ate no breakfast and about 11 A.M., she fell to the floor from shear weakness. 
There were no other symptoms except that she was so confused she could not dial the telephone to 
summon aid. On the following day she had a similar experience. On January 20th, 1950, again she 
ate no breakfast; and about 11 A.M., in her mother's presence, became confused, fainted, and suf- 
fered a convulsion. The patient was then referred to the Mercy Hospital Emergency Room where 
she was found incoherent, uncooperative, and had to be restrained. A diagnosis of post-partum 
psychosis was made, and she was committed to a mental hospital. 

Upon arrival at the mental hospital "the patient was in a semi-comatose state and had froth at 
the angles of her mouth." A physical and neurologic examination revealed nothing abnormal, and 
the patient awoke spontaneously 3 hours after admission. An electroencephalogram was interpreted 
as normal, as was all routine laboratory work except for a fasting blood sugar of 53 mgm. per cent. 
Interviews showed the patient's sensorium to be perfect, and her mental status was normal. The 
impression was: ' The equilibrium which this obsessive and dependent woman has so far maintained 
is upset by the birth of a child; in consequence, she develops hysterical symptoms." 

* From the Department of Medicine, Mercy Hospital, University of Maryland School of Medi- 
cine. 

t Received for Publication December 26, 1950. 

174 



MULLER AND SP ITT ELL— TUMOR OF PANCREAS 



175 



During her 25 days of confinement, the patient was symptom-free, but her fasting blood sugar 
was constantly low. A three hour glucose tolerance on February 9, 1950, showed a fasting sugar of 
63 milligrams per cent, 100 mgm. per cent at one hour, 80 mgm. per cent at 2 hours, and 65 mgm 
per cent at 3 hours. The patient was discharged from the mental hospital on February 14, 1950, for 
further investigation of the hypoglycemia. During the next 3 months, she showed constantly low 
fasting blood sugars and was treated by a high protein diet and frequent feedings. Six hour glucose 
tolerance curves on March 17, 1950, and July 7, 1950, showed very low fasting and final blood 
sugars (See Figure 1). She remained symptom-free until July 4, 1950, when she became extremely 
confused but was immediately relieved by a cola drink. Because of her continued weakness and 
apparent lack of response to a high protein diet, the patient was hospitalized. 

A family history showed that the patient's mother had died of carcinoma of the breast. Her past 
history was negative except for a cervical biopsy in 1947 for intermenstrual bleeding. The review of 
systems was essentially negative with no evidence of previous hypoglycemic attacks. A physical 



170-1 

BLOOD 
SUGAR l6 °- 

MGM% 

150 H 



GLUCOSE TOLERANCE CURVE 

ON 3-17-50 

ON 7-7-50 

— ON 8-7- 50 




y 2 ■ 

TIME IN HOURS 

Fig. 1. Glucose tolerance curves 



examination on admission to the hospital showed a well developed and nourished white female in 
no distress. Her blood pressure was 120 mm. mercury systolic and 76 mm. mercury diastolic. The 
remainder of the physical examination was within normal limits. 

Laboratory studies showed normal hematologic aspects. An abnormal solute eosinophile count was 
222 per cubic millimeter. The urinalysis was normal; blood urea was 23 mgm. per cent; cholesterol 
210 per cent; Kahn test for syphilis was negative; sedimentation rate was 12 mm. per minute, 
corrected; stool examination was negative for blood ova or parasites. Fasting sugars were 65 mgm. 
per cent on August 7, 1950, and 76 mgm. per cent on August 8, 1950. A 6 hour glucose tolerance 
test on August 7, 1950, is shown in Figure 1. Skull and chest roentgenographs were negative. Basal 
metabolic rate was within normal limits. 

The patient's clinical course, the repeatedly abnormal glucose tolerance tests with fasting blood 
sugars below 50 mgm. per cent, the absence of evidence of liver, thyroid, pituitary, or other diseases 
causing hypoglycemia; and her failure to respond to conservative management with high protein, 



176 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



low carbohydrate diet; were considered indication for surgical exploration for an islet cell tumor of 
the pancreas. 

On August 13, 1950, under spinal anesthesia, an operation was performed by Dr. H. H. Burns. 
A small tumor, about 1 centimeter in diameter, was removed from the lower border of the pancreas 
at the junction of the head and body. During the operation, she was given 5 per cent glucose in nor- 
mal saline, intravenously, at a continuous rate. Blood sugar studies during the operation seemed to 
indicate an insulin content of the tumor (see Figure 2). Her post-operative course was essentially 




Fig. 2. Blood studies during operation 

a. Immediately preoperative 

b. During operative exposure of pancreas 

c. Immediately after manipulating and removing tumor 

d. Immediately after closing skin 

e. 2\ hours postoperative 

f. 3§ hours postoperative 



uncomplicated, and blood sugar studies showed fasting levels from 94-144 mgm. percent. On August 
22, 1950, a 6 hour glucose tolerance curve Was normal (Figure 3). 

The pathologic report by Dr. W. C. Merkel was as follows: Gross: A round tumor 1 cm. in diam- 
eter. Microscopic: The section presents an area composed of polyhedral cells made up of a mixture 
of basophilic and fasciculated cells. The cells are quite uniform in morphology and have a tendency 
to group around vascular sinusoids, and this alignment is so close to the endothelium that it is diffi- 
cult to separate the sinusoids from the alveoli. There is a marked increase in the vascularity and 
variation in the sinusoids, some of which are extremely large and distended with well preserved 
red cells. The nuclei and cells are uniform in shape. There is no encapsulation, but very careful 
displacement of adjacent pancreatic parenchyma can be demonstrated. The surrounding parenchyma 



MULLER AND SPITTELL— TUMOR OF PANCREAS 



177 



presents normal pancreatic tissue, including well preserved islands of Langerhans. There is no 
inflammatory reaction. Diagnosis: Islet cell adenoma of the pancreas. 



BLOOD 
SUGAR 
MGM% 




I 2 3 

TIME IN HOURS 



Fig. 3. Six hour glucose tolerance nine days after operation 



Recently, Crain and Thorn (9) tabulated all of the reported cases of islet cell 
tumors of the pancreas. The following signs and symptoms were found in patients 
with islet cell tumors and tabulated as follows (9). 

1. Loss of consciousness 58% 

2. Confusional state •. 54% 

3. Weakness and fatigue 41% 

4. Deep coma 40% 

5. Sweating £■% . 36% 

6. Drowsiness and stupor . 35% 

7. Light headedness 30% 

8. Visual disturbance. . . . 30% 

9. Amnesia 28% 

10. Clonic convulsions 24% 

1 1 . Noisy behavior 20% 

12. Headaches. 20% 

13. Tremor . 18% 

14. Hunger 14% 

15. Positive Babinski 13% 

16. Paresthesias 13% 

17. Irritability . 11% 

18. Transient hemiplegia 10% 

19. Abdominal pain 8% 

20. Palpitation : 3% 

The tabulation of the distribution of insulomas by Crain and Thorn (9) is also of 
importance (Chart I). Differences of opinion have existed as to the distribution of the 
tumor. One case (13) of total pancreatectomy has been reported in which the tumor 
could not be found at operation. A very small tumor was found in the head of the 



178 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 







';3 



ffWgffg^&£g&ra?*' 



M 

Fig. 4. Photomicrograph of tumor 
a. Low power photomicrograph of tumor growth, (Top) showing thin capsule surrounding the 
adjacent compressed pancreatic tissue. 

1). High power photomicrograph, (Bottom) showing details of tumor cells. 

removed gland. Chart I shows the chances of serious error in total pancreatectomy 
for an islet cell tumor that cannot be found at operation. 






MULLER AND SPITTELL— TUMOR OF PANCREAS 



179 




6 ABBERENT PANCREAS 

BENIGN INSULINOMAS 




I ABBERENT PANCREAS 

MALIGNANT INSULINOMAS 

Chart I. Location of reported benign and malignant insulinomas 

The causes of spontaneous hypoglycemia are many. The following excellent 
etiologic classification has been listed by Conn (10). 

I. Organic — recognizable anatomic lesion 

A. Hyperinsulinism 

1. Pancreatic island cell adenoma 

(a) Single 

(b) Multiple 

(c) Aberrant 

2. Pancreatic island cell carcinoma 

(a) Localized 

(b) With metastases 

3. Generalized hypertrophy and hyperplasia of the islands of Langerhans 

B. Hepatic disease 

1. Ascending infectious cholangiolitis 

2. Toxic hepatitis 

3. Diffuse carcinomatosis 

4. Fatty degeneration of "fatty metamorphosis" 

5. Glycogenosis (von Gierke's disease) 

C. Pituitary hypof unction (anterior lobe) . . 

1. Destructive lesions (chromophobe tumors, cysts) 

2. Atrophy and degeneration (Simmons' disease) 

3. Thyroid hypofunction (? secondary to pituitary hypofunction) 

D. Adrenal hypofunction (cortex) 

1 . Idiopathic cortical atrophy 

2. Destructive infectious granulomas 

3. Destructive neoplasms 

E. Central nervous system lesions (hypothalamus of brain stem; interference with nervous 
control of blood sugar) 

II. Functional — no recognized anatomic lesion but explainable on basis of unusual somatic function 

A. Hyperinsulinism (imbalance of the autonomic nervous system): hypoglycemic fatigue; 
nervous hypoglycemia; functional hypoglycemia; reactive hypoglycemia 

B. Alimentary hyperinsulinism (rapid intestinal absorption) 

1. After gastroenterostomy 

2. After gastric resection (partial or total) 



180 



BULLETIN OF THE SCHOOL OF MEDICINE, V. OF Ml). 



C. Renal glycosuria (severe degrees of low renal threshold for dextrose) 

D. Lactation 

E. Severe continuous muscular work 
III. Miscellaneous 

A. Factitious (surreptitious insulin administration) 

B. Postoperative hypoglycemia 

C. Severe inanition 

D. Unknown 

Conn (10) states that more than 80 per cent of the cases of hypoglycemia are 
caused by one of the following: 1) Functional hyperinsulinism, 2) Organic hyper- 
insulinism, 3) Hepatogenic hypoglycemia. Hepatogenic hypoglycemia is usually not 
difficult to differentiate clinically. The differentiation of functional and organic hy- 
perinsulinism may be more difficult. Figure 5 from Conn (10) gives the usual glucose 



220 

BL00D 200 H 

SUGAR 

mg/.oocc j80 _ 

160 - 

140 - 

120 - 

100 - 

80 - 

60 - 

40 - 

20 





/GLYCOSURIA \ 



I 




•HEPATOGENIC 

HYPOGLYCEMIA 



NORMAL 
iFUNCTIONAL 
HYPERINSULINISM 



ORGANIC 
HYPERINSULINISM 



HOURS 



Fig. 5. Dextrose tolerance curves in spontaneous hypoglycemia (3 types) 

tolerance curves found in these conditions. The outstanding differences are apparent. 
Organic hyperinsulinism shows a fasting sugar below 50 mgm per cent. The curve 
usually is low, returning to hypoglycemia levels in 5 to 6 hours and remaining low. 
This is not always true as shown by this case and others. The functional hypogly- 
cemia curve typically begins with a normal fasting sugar but falls to hypoglycemic 
levels in 2 to 3 hours. The hepatogenic type typically shows a low fasting sugar 
followed by a curve of the diabetic type. The tolerance tests are not always reliable, 
and all three types of curves have been reported in the presence of islet cell tumors 
(11). Many factors influence the glucose tolerance curve (2), limiting the value of this 
test in differential diagnosis. Furthermore, Duff (12) reported that only 64 of 90 
islet cell tumors were functioning clinically. 

It is generally agreed, however, that in the absence of other organic disease causing 
hypoglycemia, a blood sugar, after a prolonged fast of less than 50 mgm per cent, 



MULLER AND SPITTEL— TUMOR OF PANCREAS 181 

is the best criterion for the diagnosis of an islet cell tumor and differentiation of 
functional hypoglycemia. 

SUMMARY 

A case of an islet cell tumor of the pancreas, originally diagnosed as post-partum 
psychosis, is presented. Surgical removal of the tumor effected a complete cure. 
The continuous administration of glucose during the operation in this case seemed 
important in that the blood sugar fell to hypoglycemic levels when the tumor was 
manipulated in spite of continuous administration of glucose. 

BIBLIOGRAPHY 

1. McClure, Roy D., and Brush, Brock E.: Experience with islet cell tumors. Arch, of Surgery. 

59: 507, 1949. 

2. Perkins, Herbert A., Destorges, Jane F., and Gtjttas, Charles G.: N. E. J. of Med., 

243: 281, 1950. 

3. Friedman, N. B.: Chronic hypoglycemia — Report of 2 cases with islet cell adenoma and changes 

in the hypophysis. Arch. Path., 27: 994, 1939. 

4. Murphy, Robert G., Dustin, Cecil C, and Bowman, Russell O.: Hyperinsulinism due 

to adenoma of the pancreas. J. of Lab. and Clin. Med., 24: 1050, 1939. 

5. Malamud, N. and Grosh, L. C, Jr.: Hyperinsulinism due to islet cell adenoma of pancreas 

with destruction of cerebral cortex — Preliminary report. Univ. Hos. Bull. Ann Arbor, 3: 
70, 1937. 

6. Whipple, Allen O., and Frantz, Virginia Kneeland: Adenoma of islet cell with hyper- 

insulinism. An. of Surg., 101: 1299, 1935. 

7. Campbell, Walter R., Graham, Roscoe R., and Robinson, William L.: Islet cell tumors of 

the pancreas. Am. J. Med. Sci., 198: 445, 1939. 

8. White, Benjamin V., and Gildea, Edwin F.: Adenoma of the pancreas and hyperinsulinism. 

N. E. J. Med., 217: 307, 1937. 

9. Crain, E. L., and Thorn, G. W.: Functioning pancreatic islet cell adenomas. Medicine, 28: 

427, 1949. 

10. Conn, J. W.: Spontaneous hypoglycemia. J. A. M. A. 134: 130, 1947. 

11. Tedstron, M. K.: Hypoglycemia and hyperinsulinism. An. Inter. Med., 7: 1013, 1934. 

12. Duff, A. L.: Pathology of islet cell tumors of pancreas. Am. J. Med. Science, 203: 437, 

1942. 

13. Priestly, James T., Comfort, Manfred W. and Radcliffe, James, Jr.: Total pancreatec- 

tomy for hyperinsulinism due to an islet cell adenoma. Ann. Surg., 119: 211, 1944. 



EDITORIAL 

LIMITING FACTORS IN THE USE OF ANTIBIOTICS 

The writer of the book of Ecclesiastes very cogently wrote: "The thing that hath 
been, it is that which shall be; and that which is done is that which shall be 
done; and there is no new thing under the sun." Although we have used the anti- 
biotic drugs for only a decade, the basic concept of their use is centuries old. The 
ancient Greeks used warm soil to promote healing. The Servian peasants for centuries 
employed molds in the treatment of wounds. In 1760 in The Old English Herbals 
it was noted that molded bread was useful in facilitating the healing process in 
wounds. But during the last decade the use of the antibiotic drugs has made a mo- 
mentus impact upon the medical practice. 

The extent to which the antibiotic drugs are used is reflected in the volume of 
their industrial production, which now outranks that of all other medicinals. It has 
been estimated that in 1948 penicillin and streptomycin alone accounted for more 
than one-half of the total of manufacturer's income from the sale of synthetic 
drugs. This figure is especially impressive when it is realized that penicillin first 
became available commercially in 1943 and that streptomycin was not offered for 
sale until two or three years later. Sufficient time has elapsed for us to review with 
significant retrospection the deleterious results which have been encountered in the 
administration of the antibiotics. 

Nearly all substances which are employed as drugs produce some type of un- 
desirable side reaction. The nature and severity of these untoward effects must 
always be weighed against the value of the drug as a therapeutic agent in any 
disease condition. Indeed the antibiotics as a class are comparatively free from 
permanent damaging side effects when considered in the light of their therapeutic 
efficacy. Undesirable side effects do occur and in general they may be evaluated 
under the following headings: 

1. DEVELOPMENT OF RESISTANCE BY BACTERIA 

The appearance of resistant strains of microorganisms is a definite epidemiologic 
problem posed by the use of penicillin. For example, bacterial strains of staphylococci 
collected from random patients in 1943 showed a greater sensitivity to penicillin 
than those collected from random patients in 1949. The treatment of tuberculosis 
with streptomycin has always presented the problem of the emergence of resistant 
strains. Indeed it appears that the use of antibiotic drugs in conditions which can 
be adequately and successfully treated by other chemotherapeutic agents tends to 
promulgate the emergence of resistant strains of various organisms to the cur- 
rently used antibiotic agents. 

2. SUPERINFECTIONS 

A frequent complication in antibiotic therapy is the appearance of a second 
infection in patients under treatment for a primary infection. These superinfections 
are more likely to occur when very young, very old, or debilitated patients are 

182 



EDITORIAL 183 

being treated. For example, staphylococcic glossitis and pharyngitis may occur 
during streptomycin therapy. When Aureomycin, Chloramphenicol or Terramycin 
are being given, monilial infections of the mouth, tongue and vagina may occur. 
The black-tongue which may occur during penicillin therapy is probably caused by 
a secondary invader. Pneumonias caused by gram-positive rods sometimes make 
their appearance while penicillin is being administered. It is possible that proteus 
may displace other organisms in urinary tract infections which are being treated 
with Aureomycin, Terramycin and occasionally Chloramphenicol. 

3. DIRECT TOXIC EFFECTS 

In the main the toxic effects of the antibiotic drugs are few. It is well established 
that vertigo and deafness may result from the injury of the eighth cranial nerve 
during streptomycin therapy. Chloramphenicol is reported to have produced leuko- 
penia, granulopenia and anemia in a few patients. Instances, however, are extra- 
ordinarily rare. Penicillin, but notably Aureomycin, Terramycin, and to a lesser 
extent Chloramphenicol, produce gastrointesintal symptoms when administered by 
mouth. In many patients these symptoms are disconcerting and extend over con- 
siderable periods of time. Polymyxin, Neomycin and Bacitracin have been known to 
produce definite kidney damage. 

4. HERXHEIMER REACTION 

Occasionally when patients have been treated with penicillin for syphilis, primary 
reactions have resulted. Some fatalities have been reported in patients with cardio- 
vascular syphilis treated with penicillin. It is deemed most prudent to use bismuth 
first in those cases of syphilis with aneurisms or extensive aortitis. 

Thus it becomes quite clear that although the antibiotic drugs have scored a 
shining mark of success in the conquest of the infectious diseases, their promiscuous 
use and unwarranted administration to patients are not without repercussions both 
from the point of view of the epidemiology of disease and the patient's general 
comfort. 

John C. Krantz, Jr., Ph.D. 



CLINICO-PATHOLOGIC CONFERENCE 

From the Case Histories, University Hospital, Baltimore 

CLINICAL HISTORY 

In June of 1950 a 21 year old white female who had lost 35 pounds first noticed the 
onset of anorexia, fatigability, shortness of breath and a non-productive harassing 
cough. It was considered that a vacation might help her, so she and her husband 
took a lengthy motor trip. Since her symptoms showed a steady progression, and 
because of the cough, she consulted her family physician. Following a roentgenograph 
of her chest, reported as "suspicious", she went to a state tuberculosis detection 
center. There, the chest films were repeated and extensive studies were performed on 
her sputa. However, mycobacteria were not demonstrated. She was then referred 
to the University Hospital for further study and treatment. At the time of admission, 
she had lost approximately 35 pounds in weight. 

Her health had been good until the present illness. She had had no serious illnesses, 
operations or injuries. She had shortness of breath with upper respiratory infections 
and swelling of feet and legs after prolonged standing. She offered no history indicative 
of rheumatic fever. 

On admission to the hospital her temperature was 97.8 F. ; pulse rate, 84 per minute; 
respiratory rate, 20 per minute; and systolic and diastolic pressures, 118 and 70 
millimeters of mercury. The patient was described as a well developed, well nourished 
21 year old white female lying quietly in bed. Her color was good. She had a frequent 
dry, hacking cough. In spite of the 35 pound weight loss, she was described as rather 
large. There were striae present over the hips. No abnormalities of the head, eyes, 
nose, mouth or throat were noted. There was a firm, discrete, freely movable non- 
tender node in the right posterior cervical chain which was the size of a lima bean. 
There was a similar node in the right femoral region. Aside from small, shotty 
inquinal lymph nodes there was no other significant lymphadenopathy. The thyroid 
was not palpable. The trachea was in the midline. Both lungs expanded well and 
were resonant to percussion. The breath sounds were bronchovesicular. There were 
rales at both lung bases. The heart was normal. An examination of the abdomen 
revealed a greatly enlarged spleen, extending 5 cm. below the costal margin and a 
firm non-tender liver which extended about 2 cm. below the right costal margin. 
The remainder of the examination was negative. Roentgenographs were made of the 
chest (Fig. 1) and hands. 

The urine was straw colored, acid and devoid of albumin, sugar, casts and blood 
cells. An examination of stool specimens was negative. There were no skin responses 
to tuberculin, purified protein derivative, brucallergin, coccidiodin, or histoplasmin. 
The blood hemoglobin concentration was 14.5 grams or 100 per cent. An hemogram 
included an erythrocyte count of 5.95 million; a blood volume of 44; an erythrocyte 
sedimentation rate of 18 millimeters per minute; and a leucocyte count of 6000 cells 
per cubic millimeter. Sixty-nine per cent of the white blood cells were neutrophilic 
polymorphonuclear granulocytes; 25 per cent, lymphocytes; 1 per cent, monocytes; 

184 



CLINICO-PA THOLOGIC CONFERENCE 



185 



and 5 per cent, eosinophilic granulocytes. The blood mean corpuscular volume, 
hemoglobin, and hemoglobin concentration were 74, 24, and 33, respectively. The 
bleeding time was 2 minutes and 30 seconds. The clotting time was 6 minutes and 3 
seconds. The blood contained 16 milligrams of urea nitrogen in each one hundred 
cubic centimeters and 82 milligrams of glucose. Total serum proteins were determined 
to be in concentration of 9.74 and 9.90 grams per hundred cubic centimeters. The 
serum globulin was definitely elevated in each determination. Each 100 cubic centi- 
meters of blood contained 223 milligrams of cholesterol; .3 milligrams of direct 
bilirubin, .1 milligrams of indirect bilirubin, 9.7 milligrams of calcium, and 3.9 




Fig. 1. Roentgenograph of chest showing extensive shadows in both lungs 

milligrams of phosphorus. The alkaline phosphatase was reported in concentration 
of 1.26 units per 100 cubic centimeters of serum. Thymol turbidity was reported as 
12.9 units. There was no retention of bromsulphaline. The basal metabolic rate was 
accelerated 40 per cent. The serologic test for syphilis was negative. Agglutinins for 
Brucella, Pasteurella, Eberthella, Salmonella and Rickettsia were negative. There 
were no Mycobacteria in the gastric washings. 

The patient was completely afebrile during her entire stay. On the 15th of No- 
vember a sternal puncture was done and marrow was obtained for guinea pig inocu- 
lation and culture on Sabaroud's medium for fungi. On the 15th of November a liver 
biopsy was obtained by aspiration. On November 22 a node in the right femoral 
region was removed for microscopic study. She gained 3 pounds during her hospital 
stay and was discharged improved on the 27th hospital day. 



186 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

CLINICAL DISCUSSION 






Dr. Alex Murphy: I notice that there is a fairly meticulous geographic study of her 
holiday, but I feel that this really is not relevant because it was after she developed 
her symptoms that this trip was taken. 

I find the basal metabolic rate very difficult to reconcile with the clinical aspects. 
Forty per cent is quite an increase, and yet this woman had a pulse of 84, was lying 
quietly in bed, had no evidence of cardiac failure and had no thyrotoxicosis. There- 
fore, I challenge the accuracy of this figure. 

I would divide this problem into two phases. First, this young woman with no 
significant story in her past, who was obviously too fat and overweight, complained 
of fatigability, some weight loss, shortness of breath and a non-productive harassing 
cough. Quite naturally, tuberculosis was suspected and roentgenologic studies were 
made, which resulted in the discovery of abnormal shadows in the lungs. These 
shadows confirmed, to some extent, the suspicion of the physician and extensive 
studies of the sputum were made. These failed to reveal the presence of M. tubercu- 
losis. At that time there was a search made for fungi, and none of the ordinary fungi 
were discovered. The patient apparently continued to lose weight and came into the 
hospital on October 30, some 5 months after the onset of her illness. At that time, 
she showed some signs in her lungs — post-ptussic rales, rales at both bases, a palpable 
node in the neck and in the groin , a very large spleen and a considerable hepatic 
enlargement. She was still described as "fat." There was a tendency to erythrocytosis. 
I would rather attribute that to some physical difficulty because of interference with 
gaseous exchange in the lungs. This is not adequately explained by tuberculosis. It 
is unusual to find signs at both bases in patients with early tuberculosis. While her 
spleen might have been enlarged in a miliary form of tuberculosis, she does not 
present the clinical aspects of miliary tuberculosis. Even after 5 months her cough 
was non-productive. A tuberculin test was negative. I have seen negative tuberculin 
tests in people who are overwhelmed with a miliary tuberculosis, but again the 
impression that one gets from this case is not that of a desperately ill patient . She 
was afebrile and her pulse rate was not increased. With the condition presented on 
her admission to the hospital, I would seek the agent which could be responsible for 
lung lesions, lymphadenopathy, liver and splenic enlargement and with changes in 
her plasma proteins. One of the first things that enters one's mind, of course, is the 
lymphomas. Hodgkin's disease might deserve consideration. However, the signs and 
symptoms in this patient are not characteristic of Hodgkin's disease. I cannot 
believe that the results of her blood tests would have been as they were, nor would 
she have a complacent countenance had she been alarmingly ill. I believe a relatively 
benign process caused all those signs and symptoms. Furthermore, we note that the 
patient gained a little weight during her hospital stay. The plasma protein was 
negative. We do get an increase in globulin in tuberculosis, but the only persons in 
whom I have observed that were those with a long-standing disease, so I really 
believe tuberculosis might be eliminated. Also, plasmacytosis or multiple myeloma 
cause an increase in the plasma protein, but once again I think that the blood count 
would be against this. 

I notice that a sternal marrow puncture was performed and suspect that plasma 
cells were not found. I haven't seen them in brucellosis. Kala-azar can be dismissed. 



CLINICO-PATHOLOGIC CONFERENCE 187 

There is one condition which to me seems capable of providing an adequate explana- 
tion of the whole condition, and that is sarcoid. Sarcoid is responsible for enlarge- 
ment of lymph nodes and very frequently it causes lung changes which might be 
interpreted as tuberculosis. It will also lead to enlargement of the spleen and liver. 
The plasma protein is usually elevated in sarcoid, and, not infrequently, the calcium. 
The fact that the calcium is not elevated does not deter me in suggesting that sarcoid 
appears the most likely explanation to me. I notice that in spite of a liver biopsy, a 
node was removed some days later. It was suggested that the information coming 
from the liver biopsy was not satisfactory to the pathologist. I am rather disturbed 
by the sternal puncture and cultures which made me wonder if brucellosis can 
produce this syndrome. However, the agglutinations were negative. Therefore, tu- 
berculosis is disproved; brucellosis does not appear to be the diagnosis; and Hodgkin's 
disease is dismissed because the patient does not appear ill enough. I am more or 
less left with sarcoidosis as my diagnosis. 

Dr. Walter Kilby: We have two sets of roentgen films. One set was made on ad- 
mission and the other about two weeks later. 

Dr. Murphy: If I were seeing the films without knowing anything about the case, 
the three things that would be suggested would be carcinomatosis, miliary tubercu- 
losis, or sarcoid. I have had no experience whatsoever with histoplasmosis. I cannot 
see the glandular enlargement that I would expect in sarcoidosis. I still "stick" to 
my diagnosis of sarcoidosis. 

Dr. Kilby: We were quite amazed when we saw these roentgenograms, and also 
quite bewildered. The very numerous lesions extend throughout both lungs. The 
fine patches of infiltration are almost equal in size. Although we attempted to relate 
the film characteristics with many diseases, we were unable to draw any conclusions. 
We were quite bewildered until we heard a report of the biopsy. 

PATHOLOGIC DISCUSSION 

Dr. Hugh R. Spencer: The diagnosis in this case was made on the basis of biopsy 
material. The first specimen was obtained by aspiration from the liver. In the sections 
made from this tissue there were several small closely approximated, though discrete, 
lesions composed of large vacuolated cells of the epithelioid type. There was rela- 
tively little reaction in the surrounding liver tissue. Appropriate stains failed to 
reveal acid-fast organisms. The lesion was reported as granulomatous in character, 
probably sarcoidosis. 

The second specimen was a lymph node removed from the right femoral region. In 
this node the structure was considerably distorted and much of the lymphoid tissue 
was replaced by small, well-circumscribed masses of epithelioid cells. The cells 
appeared somewhat vacuolated and in the centers of some of the lesions giant cells 
of the Langhans' type were noted. A few of the giant cells contained asteroid bodies. 
None of the lesions showed central caseation. These sections presented aspects 
typical of sarcoidosis. 

Sarcoidosis is a generalized systemic condition characterized by tubercle-like 
lesions. The organs most commonly affected are the lymph nodes, lungs, spleen, skin, 
short bones of fingers and toes, uveal tract and the salivary glands. 

Boeck in 1899 published simultaneously in Norway and in the United States a 



188 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

report of some apparently rare skin lesions that have since come to be associated 
with his name. The bluish nodules and infiltrating lesions of the skin, he interpreted 
as sarcoma-like and hence applied the name sarcoid to the condition. The name 
sarcoidosis has been retained in this country, but in Europe the disease is commonly 
referred to as benign lymphogranulomatosis. 

The skin lesions of Boeck are only one of many regional manifestations of the 
disease. Much confusion of terminology has resulted from the fact that a number of 
syndromes based upon the particular organs involved were described. Lupus-pernio 
of Besnier, osteitis tuberculosa multiplex cystica of Jungling, and uveo-parotid fever 
of Heerfordt which were originally described as singular syndromes are now known 
as sarcoidosis. 

Sarcoidosis, once considered a rare curiosity of interest chiefly to the dermatologist, 
is now known to be relatively common. Well over 1000 cases have been reported. 
The disease is encountered in all parts of the world, with apparent prevalence in 
the cooler countries, especially in Scandinavia. It is difficult to make even an ap- 
proximation of the actual incidence. With recruits in the Swiss Army the incidence 
is given as 0.13 per thousand. Figures in Denmark are about the same. 

Sarcoidosis has been reported in the extremes of age, but probably more than half 
of the patients present evidence of the disease before the age of thirty and two-thirds 
before the age of forty. 

In this country an unusually high incidence has been noted among Negroes. In a 
group studied in Philadelphia, eighty per cent of the patients were Negroes and in 
an Army Hospital Group the incidence for Negroes was fifty per cent. All of these 
figures are higher than the proportion of Negroes in the general population. 

In sarcoidosis the lesions in all tissues are the same. They consist of small cellular 
tubercles, composed of large pale epithelioid cells with or without giant cells. The 
lesions are discrete, they show the same stage of development, there is little or no 
caseation necrosis and little or no surrounding collar of lymphocytes. The giant cells 
may be either typical Langhan's or of the large foreign body type. Some of the 
giant cells may contain asteroid, radial, or laminated inclusion bodies. These, how- 
ever, are not pathognomonic since they have been described in the giant cells of 
leprosy, torulosis, beryllium lesions and in foreign body granulomas. 

Little is known about the development of the lesions. They are thought to begin 
in perivascular tissues with a deposition of lymphocytes, to be replaced later by 
epithelioid cells. They may persist in characteristic form for indefinite periods. 
Resolution or scarring appear to be their ultimate fates. 

The lesions have been found at one time or another in practically all organs of 
the body. The lymph nodes are involved in fifty to seventy-five per cent of cases. 
The intrathoracic nodes are those most consistently affected. The lymph nodes 
remain discrete. The enlargement is rarely associated with pressure and obstructive 
phenomena. The tonsils are commonly involved in this disease. The spleen appears 
to be frequently involved. In one series of 29 cases collected from the literature, 
splenic lesions were noted in 21. The weight of the spleen in this disease may oc- 
casionally exceed 1000 grams. Hypersplenism has been described in cases with 
splenic involvement. Lesions in the liver occur only slightly less often than in the 
spleen. Hepatomegaly may be marked. In a number of cases (as in this case) the 



CLIN I CO-PAT HO LOGIC CONFERENCE 189 

diagnosis has been suggested as result of study of aspiration biopsy from the liver. 
Involvement of the pulmonary parenchyma is often a prominent feature of this 
disease. There may be extensive involvement in the complete absence of symptoms. 
The lesions as seen with the aid of roentgen rays may be miliary in type or they may 
show a linear distribution. Active pulmonary tuberculosis is said to supervene in 
about 10 per cent of the cases. In the recorded autopsies the heart and kidneys are 
involved in about 20 per cent of the cases. Hypercalcemia and renal calculi are 
occasionally encountered. Bone is involved in 15 to 25 per cent of the cases. The 
lesions are cystic or cystoid areas of medullary rarefaction which are more commonly 
encountered at the short bones of the hands and feet, but similar lesions have been 
demonstrated in the long bones and in the vertebrae. Lesions in the skin and mucous 
membranes occur in about one-half of the cases. The skin lesions may be miliary, 
nodular or diffuse plaque-like. Healing may leave no residue or may result in a 
pitted scar. Eye involvement occurs in 25 to 50 per cent of the cases producing iritis 
and irido-cyclitis. Uveitis may be associated with enlargement of the salivary glands, 
especially the parotid. The tuberculin reaction is negative in from 60 to 70 per cent 
of the cases. The Kveim test which has been found to be positive in a fair percentage 
of patients with active sarcoidosis, is a recent development. In this test the intra- 
dermal injections of extracts of sarcoid material produce characteristic skin lesions in 
patients with active sarcoidosis. The reaction appears to be rather specific, but the 
antigen is much less so. Extracts of normal human spleens, of lymph nodes in lymph- 
oid leukemia, tubercle bacilli and other substances may produce characteristic lesions 
in active sarcoid cases. 

The cause of the disease is not known. The tubercle bacillus and an unknown 
agent, perhaps a virus, remain the most favored possibilities. 

DISCUSSION 

Dr. Murphy: Might I ask the explanation of the 40 per cent basal metabolic rate? 

Dr. T. Nelson Carey: I felt that the high metabolic rate was caused by respiratory 
insufficiency. Her respiratory rate was much more active than one would expect 
considering her apparent good health. The clinical problem was mainly to exclude 
miliary tuberculosis. 

Dr. M. C. Pincoffs: There are just one or two comments I would like to make. 
Before convening here, Dr. Murphy asked me if we have used ACTH in sarcoidosis. 
We have done so in one case of uveo-parotid fever showing very serious eye involve- 
ment. The majority of cases with uveo-parotid fever regress after a long course, but 
not only was this woman losing her eyesight, her general condition was alarming 
and furthermore was deteriorating rapidly. I have seen her once since ACTH was 
given. In my opinion, there were no beneficial effects, even though there was slight 
regression in the ocular lesions. While this case, under discussion, had obvious 
dyspnea, it is astounding how many cases of sarcoid occur without impairment of 
respiratory function. A physician from Washington was admitted here because of 
opacities in a roentgenogram of his chest. He had extensive bilateral, doom-portending 
bands of infiltration throughout the lung parenchyma. Nevertheless, he had lost 
comparatively little weight, and there was no breathlessness. 

One other point I would like to comment on is in connection with granulomata of 



190 BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MB. 

the liver. Dr. Klatskin, whom I heard at Yale speak on granulomata of the liver, 
was particularly interested in sarcoid and generally interested in other granulomatous 
conditions that may be diagnosed by liver biopsy. He took the entire core from the 
needle which he had used for his aspiration and serially cut the entire specimen. 
That, of course, is a very laborious process. He had punctured a great many cases of 
tuberculosis that did not have apparent liver involvement and found in them a high 
percentage of minute granulomatous lesions. Some of the lesions showed caseation. 
In only one, could he find Mycobacteria. He offered 600 cases in which liver biopsies 
had been done and in only four were granulomata found. He found liver granulomas 
in a high percentage of sarcoid, a fair percentage in tuberculosis and lymphoma, and 
very rarely in conditions in which there was no indication for making a liver ex- 
amination. But when he came to comparing the histology of the granulomata, he 
found he could not make any distinction. He could not tell sarcoid from tuberculosis 
except when tuberculosis had reached an advanced stage, and had its typical mantle 
of surrounding cells and caseation in the center. 






OBSTETRICAL CASE REPORT 

From tlie Department of Obstetrics, University of Maryland School of Medicine 

M. E., a 23 year old para 0-0-0-0 was first seen September 18, 1950, in consultation. 
Her past and family histories were non-contributory and the pregnancy had reached 
the 36th week without difficulty. She had just been admitted to the contagious 
ward after an illness at home of 3 days duration. The medical diagnosis was bulbar 
spinal poliomyelitis. Her temperature was 102 F, the spinal fluid white blood cells 
numbered 750 per cubic millimeter with 60 per cent polymorphonuclear neutrophils. 
The respiratory ventilation meter registered a vital capacity of only 500 cc. (normal 
2500 to 3000). It was the opinion of the internist that this patient should in the 
very immediate future have a tracheotomy performed and be placed in a respirator. 
It was his opinion that cyanosis, respiratory distress and death would ensue if this 
were not done. 

Question: What should the obstetrical treatment be under these circumstances? 

Discussion: Until quite recently it was believed, taught and felt that any inter- 
ference with the pregnancy in cases of anterior poliomyelitis was absolutely contra- 
indicated and would result in infinitely more harm than good. This is probably true 
in the majority of the cases, the exceptions being the occasional patient as pictured 
above: viz; pregnancy near term in a patient suffering from poliomyelitis with bulbar 
involvement. In this small group the additional respiratory embarrassment incident 
to the enlarged uterus may be enough to tip the balance of the scales against the 
individual. It is in this group, and in this group alone, that there is any justification 
for promptly emptying the uterus. Time is of the essence here and the abdominal 
route should be chosen. This may sound like rank heresy to many, and a few years 
ago it would have been heresy, but with the liberal use of the antibiotics, many of 
the dangers of the operation have been eliminated and the actual results have 
improved. If the patient can be delivered before cyanosis and respiratory distress 
have developed and before tracheotomy has been done, the operation is simpler 
and the results better. On the other hand, in those who have already been placed in 
a resuscitor and tracheotomized and who continue to show increasing distress, the 
improvement following section is often most dramatic. The anesthetic of choice 
appears to be cyclopropane in a closed system with positive pressure. 

Actual treatment and result: A laparotrachelotomy was done without difficulty. 
The baby, weighing 2375 grams required a moderate amount of resuscitation. Follow- 
ing operation, a tracheotomy was done and the patient was placed in a respirator. 
She remained in the apparatus for several months and gradually recovered. The 
baby did well. 

The Reader is referred to an excellent and comprehensive article by Paula Horn 
in the February 1951 issue of The Annals of Western Medicine and Surgery. 



191 



INDEX TO VOLUME 36—1951 



Blair, Emil, 133 

Book Reviews, 44, 45, 100, 101, 142 
Bradley, J. Edmund, 86 
Brantigan, Otto C, 57, 133, 152, 171 
Bubert, Howard M., 115 

Cancer detection and therapy, II. Methods of 
preparation and biological effects of 
metallo-porphyrins. 

method 1, 3 

method 2, 4 
Carr, C. Jelleff, 48 

Clinico-pathologic conferences, 38, 92, 137, 184 
Cortisone, the effect of, in the treatment of 

typhoid fever, 143 
Culver, Perry J., 48 
Demarest, Elinor W., 8 

Diagnosis and treatment of the acute abdomen, 
103 

principles of treatment in the acute abdomen, 
106 

inflammation, 107 

appendicitis, 107 

acute gall-bladder disease, 109 

perforation, 110 

perforated sigmoid diverticulum, 111 

intestinal obstruction, 112 

mesenteric thrombosis, 114 

summary, 114 
Editorials 1, 47, 182 

Fasciae and subperitoneal fascial spaces of the 
male pelvic cavity, 60 

parietal endopelvic fasciae, 60 

neurovascular sheaths, a reality, 61 

line of anchorage, 61 

general appearance of neurovascular sheaths, 
63 

superior hypogastric wing, 65 

retrovesical space, 72 

the space of retzius, 81 

the retrorectal space, 82 
Ferguson, L. Kraeer, 103 
Figge, Frank H. J., 3 
Finesinger, Jacob E., 163 
Globin insulin with zinc in diabetic outpatients, 

156 
Gout — recent advances, 126 
Intrathoracic structures, a viable pedicle graft 

for repairing, 152 
Islet cell tumor of the pancreas, 174 
Jackson, Robert L., 24 
Jennings, Erwin R., 119, 171 



Jones, Chester M., 48 
Krantz, John C, Jr., 48, 182 
Lenticulo-striate artery, 8 

cases of rupture, 12 

survey of textbooks, 12 

summary, 13 
Link, Harwood V., 16 
Manganiello, Louis O. J., 3 
Mansberger, Arlie R., Jr., 119 
Muller, S. Edwin, 174 
McCabe, Edward S., 126 
Medicine, concerning values in, 163 
Method of dividing intracardiac structures with- 
out opening the heart chambers, 57 
Moore, Marcus W., Sr., 24 

New type pull-out wire for tendon surgery, a 
preliminary report, 119 

description, 119 

technique, 119 
Obstetrics, 28 

annual report, 28 

case reports, 43, 99, 141, 191 
Osteogenic sarcoma arising in Paget's disease 
(osteitis deformans) of the calvarium, 19 

report of a case, 19 
Oster, Robert H., 86 
Parker. Robert T., 143 
Penicillin in bronchial asthma, 115 
Penton, Robert S., 57, 152 

Perforation of gastrojejunal ulcer following sub- 
total gastric resection for duodenal ulcer, 133 

case report, 133 
Pericardial coelomic cysts, 24 

case report, 24 
Proutt, Leah M., 86 

Relation between pH changes and rabbit gut 
motility in vitro, 86 

material, 86 

method, 86 
Revell, Samuel T. R., 156 
Rienhoff, William, Jr., 24 
Robinson, Harry M., 16 
Robinson, Harry M., Jr., 16 
Rodger, Robert C, 19 
Shipley, E. Roderick, 86 
Smadel, Joseph E., 143 
Smith, Edward P., Jr., 119 
Spittell, John A., 174 

Sugar alcohols-XXVIII. Toxicologic, pharmaco- 
dynamic and clinical observations on Tween 
80,48 



193 



194 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



the chemical and physical nature of Tween 80, 
48 

effect of lipase, 49 

toxicology in animals, 49 

effect on blood pressure, 50 

effect on blood cells, 51 

clinical observation and pharmacodynamics 
in man, 51 

fate of Tween 80 in man, 54 
Tendon forms for use in the treatment of severed 

tendons, 171 
Thompson, Raymond K., 19 
Tinea capitis II, studies in the treatment of, 16 

nature of drug, 16 

clinical studies, 16 



method of treatment, 17 

results of treatment, 17 
Torulosis of the central nervous system: bio- 
chemical behavior of the causative organs, 
122 

introduction, 122 

methods, 122 

results, 122 

discussion, 124 

summary, 124 
Uhlenhuth, Eduard, 60 
Wagner, John A., 19 
Wise, Walter D., 2 
W T oodward, Theodore E., 143 
Yeager, George H., 119, 171 



MEDICAL SCHOOL SECTION 
MEDICAL EDUCATION FUND PROGRESSES 

In the May 19, 1951 number of the Journal of the American Medical Association 
the leading editorial was devoted to an analysis of the aims, the organization and the 
accomplishments of the National Fund for Medical Education and the American 
Medical Education Foundation. 

Since that editorial, the School of Medicine has received its share of the first dis- 
tribution of the more than $1,000,000 already available. These funds have been pre- 
sented to the medical schools in the United States through the American Medical 
Education Foundation to be used as the school sees fit and without strings attached. 

The object of the Fund is to raise from voluntary sources, substantial sums for the 
support of the nation's medical schools. $5,000,000 has been set as the annual goal. 
Funds are to be solicited not only from physicians but from other sources such as 
organized groups and corporations. The soliciting agency for the physician is the 
American Medical Education Foundation, organized by the American Medical Asso- 
ciation, to which physicians' contributions should be sent. 

The National Fund for Medical Education includes contributions from the Amer- 
ican Medical Education Foundation. It is a non-profit organization created in 1949 
with executive offices at 535 Fifth Avenue, New York 17 New York. The Board of 
Trustees and the Advisory Council contain names not only prominent but diversified 
throughout the educational and business fields. Thus, lay and professional organiza- 
tions are joined in a common endeavor in behalf of the Nation's medical schools. 

The financial status of most of the schools of medicine in this Nation today de- 
mands additional financial support, if the quality of research and educational op- 
portunity is to continue. There can be no financial return from the raising of stu- 
dent fees. There can be but two sources of this supplementary income. To a great 
measure, each physician can determine the origin of this financial support, for if the 
National Fund for Medical Education (and for the physician, the American Med- 
ical Education Foundation) is not adequately supported, the only recourse for 
funds, from necessity, shall be from governmental sources. 

The management of the National Fund for Medical Education in conjunction with 
funds from the American Medical Education Foundation, is linked with many well- 
known foundations such as the Carnegie Foundation, the Commonwealth Fund, the 
Josiah Macy, Jr. Foundation, the Lilly Endowment and the Rockefeller Foundation. 
Funds from those foundations have thus far carried the entire administrative costs 
of the National Fund, thus making it possible for every dollar collected to flow to the 
medical schools. 

The National Fund for Medical Education has now been publicly announced. It is 
therefore incumbent upon every physician, student and friend of medical education 
to encourage repeated, continuous contributions to the effect that the aims and pur- 
poses of these foundations shall be currently and continuously achieved. 

Physicians should contribute annually to the American Medical Education Founda- 



ii BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

tion, 535 North Dearborn Street, Chicago 10. Physicians may continue to designate 
the school to which they wish their contributions to go. 

The furtherance of medical education is an obligation of every physician. The 
Alumni and friends of the University of Maryland have thus far been most generous 
and realistic in assuming this obligation. The effort should continue unabated. 

ADDITIONAL CURRICULUM CHANGES 
UNDER CONSIDERATION 

Committee Nominated to Study Possible Changes 

In 1949 the Faculty of the School of Medicine completely revised the curriculum 
for the 4th year. After 2 years of successful operation, Dr. H. Boyd Wylie, Dean, on 
June 11, 1951, issued a memorandum to the Faculty nominating a Committee to 
study in detail the current curriculum of the first 3 years to make recommendations 
to the Faculty Board for the improvement of the curricula based on the findings from 
a study of the curricula of other recognized medical schools. 

The Committee, of which Dr. Theodore E. Woodward is Chairman, has begun the 
arduous task of compiling information and recommendations. The details of the 
progress and the conclusions of this most important task will be carried in future 
editions of the Bulletin. 

PROGRESS NOTE IV 




>i 




View of construction of new Psychiatric Building as of August 5, 1951 
The American Medical Association Education Foundation needs your support. 



MEDICAL SCHOOL SECTION iii 

DEPARTMENT OF PEDIATRICS 

Dr. James Minor, Resident in Pediatrics at the University Hospital from 1950-51 
has entered the practice of Pediatrics in Norwalk, Connecticut. He is residing at 5 
Norman Avenue in Norwalk. 

Dr. Blackburn Joslin, Resident in Pediatrics at the University Hospital from 1949- 
50 is currently stationed in Heidelberg, Germany as Chief of Pediatrics. His address 
is 130 Station Hospital, A.P.O. 403, c/o Postmaster, New York, New York. 

Dr. Edward Field, Assistant in Pediatrics, successfully passed the examination 
given by the American Board of Pediatrics. 

Dr. William Morgan, who helps in the instruction of residents on affiliation at the 
Peninsula General Hospital, Salisbury, Maryland, also passed the examination given 
by the American Board of Pediatrics. 

The Seizure and Developmental Clinics were formally opened on June 22, 1951. 
The opening was attended by various members of the State and City Health Depart- 
ments, various social agencies, staff members and interested people in the field. The 
Seizure Clinic is headed by Dr. Ruth Baldwin. 

Recent publications from the Department of Pediatrics included: 

An Evaluation of a Carbohydrate-Phosphoric Acid Solution in the Management of 
Vomiting, J. Edmund Bradley, Leah Proutt, E. Roderick Shipley and Robert 
H. Oster, Journal of Pediatrics, 38: No. 1, 41-44, Jan. 1951. 

Sickle Cell Anemia, Frederick Heldrich, Journal of Pediatrics, 39: No. 1, July, 1951. 

Treatment of Hemophilus Influenzae Meningitis with Chloramphenicol and Other 
Antibiotics, Fred R. McCrumb Jr., Howard E. Hall, Jerome Imburg, Ann Mere- 
dith, Master Sergeant Robert Helmhold, Juan Basora y Defillo, Theodore E. Wood- 
ward, Journal of the American Medical Association, 145: 469-74, February, 1951. 

Hemophilus Influenzae Pyarthrosis and Meningitis Treated with Aureomycin, Black- 
burn S. Joslin and Ann Howard, Journal of Pediatrics, 38: No. 3, p. 375-79, March, 
1951. 

Dermatomyositis with Nephritis in a Negro Girl, J. Edmund Bradley, Miles E. 
Drake and H. Patterson Mack, A. M. A. American Journal of Diseases of Children, 
81: 403-407, March, 1951. 

The Relation Between pH Changes and Rabbit Gut Motility in Vitro, Leah Proutt, 
E. Roderick Shipley, Robert H. Oster, J. Edmund Bradley, Bulletin of the School 
of Medicine, Univ. of Md., 36: No. 2, April, 1951. 

Early Histologic Changes Following Obstruction of Pancreatic Ducts in Dogs: 
Correlation with Serum Amylase. G. E. Gibbs and A. C. Ivy, Proceedings of the 
Society for Experimental Biology and Medicine, 77: 251-54, 1951. 

Treatment of Juvenile Thyrotoxicosis with Propylthiouracil, Miles E. Drake, Ann 
Howard, Frederick Heldrich, Blackburn S. Joslin and Jerome Imburg, A. M. A. 
American Journal of Diseases of Children, 1951. 



iv BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

DEPARTMENT OF RADIOLOGY 
DR. JOHN M. DENNIS APPOINTED INSTRUCTOR IN RADIOLOGY 

Dr. John M. Dennis has recently been appointed to the Faculty of the School of 
Medicine as instructor in radiology and assistant roentgenologist in the University 
Hospital. 

Dr. Dennis is a graduate of the University of Maryland in the class of 1945 and 
has spent 9 months as an intern in the University Hospital. He then served 2 years in 
the U. S. Army as a roentgenologist and 2 years in the Department of Roentgenology 
of the University Hospital as a resident. He has recently returned after an additional 
year of study in his chosen field under Dr. Eugene E. Pendergrass at the University 
of Pennsylvania Hospital. In June of 1951, Dr. Dennis was certified by the American 
Board of Radiology. 

MEDICAL LIBRARY NOTES 

The following donors presented books and periodicals to the Medical Library 
between May 1 and August 1, 1951: 

Dr. Frank J. Figge Dr. Lyndon A. Peer 

Dr. H. K. Fleck Dr. Maurice C. Pincoffs 

Dr. Frank W. Hachtel Mrs. L. I. Whiteford 

Mr. W. T. Meyers Dr. H. Boyd Wylie 

Miss Elizabeth L. Clark and her sisters presented the library with a gift of great 
interest in connection with the history of the School of Medicine. The gift consists of 
a photograph of Dr. Corbin Amos, one of the earliest graduates of the School of 
Medicine, and his certificate of membership in the Medical Society of Baltimore, 
dated 1812. Both the picture and the certificate have been hung on the east wall of the 
Medical Library. 

TWO IMPORTANT POSTS TO BE FILLED BY DR. LOUIS H. DOUGLASS 

Dr. Louis H. Douglass, Professor of Obstetrics, was recently elected Chairman of the 
Sect'on on Obstetrics and Gynecology of the American Medical Association and also 
Vice-President of a newly formed American Academy of Obstetrics and Gynecology. 

DEPARTMENT OF NEUROSURGERY 

Dr. Richard G. Coblentz of the Department of Neurosurgery recently spoke at a 
meeting of the Delaware Medical Society on the subject of "Head Injuries". 



MURRAY-BAUMGARTNER 
-SURGICAL INSTRUMENT COMPANY INC.(*H 

Equipment and Supplies for: 

Doctors 

Hospitals 

Laboratories 

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5 West Chase Street Baltimore-1 , Md. 




NEW FACULTY APPOINTMENTS AND PROMOTIONS 
ANNOUNCED FOR THE ACADEMIC YEAR 

SEPTEMBER 20, 1951 TO JUNE 7, 1952 

VISITING PROFESSORSHIPS: 

Lloyd D. Felton, A.B., D.Sc, M.D., Visiting Research Professor of Bacteri- 
ology. 
(Effective June 1, 1951) 

John R. Reid, Ph.D., Visiting Professor of Psychiatry. 
(Effective September 1, 1950) 

PROFESSORSHIPS BY PROMOTION ARE AS FOLLOWS: 

C. Jelleff Carr, Ph.D., From Associate Professor of Pharmacology to Professor 

of Pharmacology. 
I. Ridgeway Trimble, M.D., From Associate Professor of Surgery to Professor 
of Clinical Surgery. 

ASSOCIATE PROFESSORSHIPS BY PROMOTION: 

Frederick P. Ferguson, Ph.D., From Assistant Professor of Physiology to Asso- 
ciate Professor of Physiology. 

D. Frank Kaltreider, A.B., M.D., From Assistant Professor of Obstetrics to 

Associate Professor of Obstetrics. 

Ida M. Robinson, A.B. B.S.L.S., From Librarian to Associate Professor of 
Library Science. 

J. McCullough Turner, Ph.D., From Assistant Professor of Physiology to Asso- 
ciate Professor of Physiology. 

ASSISTANT PROFESSORSHIPS BY PROMOTION ARE AS FOLLOWS: 

Karl F. Mech, B.S., M.D., From Associate in Anatomy to Assistant Professor 
of Anatomy. 

Robert A. Reiter, M.D., From Associate in Medicine to Assistant Professor of 
Medicine. 

Arthur G. Siwinski, A.B., M.D., From Associate in Surgery to Assistant Pro- 
fessor of Surgery. 

ASSOCIATES BY PROMOTION: 

Robert Z. Berry, A.B., M.D., From Instructor in Otolaryngology to Associate 

in Otolaryngology. 
Louis V. Blum M.D., From Assistant Pediatrician to Associate in Medicine. 
William R. Bundick, M.D., From Instructor in Dermatology to Associate in 

Dermatology. 
Jonas Cohen, M.D., From Instructor in Medicine to Associate in Medicine. 
John S. Haines, M.D., From Instructor in Urology to Associate in Urology. 
Walter Karfgin, M.D., From Instructor in Medicine to Associate in Medicine. 



vi BULLETIN OF THE SCHOOL OF MEDICINE, U. OF AID. 

Louis B. Kroll, A.B., M.D., From Instructor in Medicine to Associate in Medi- 
cine. 

H. Patterson Mack, M.D., From Instructor in Anatomy to Associate in Anat- 
omy. 

Patrick C. Phelan, Jr., A.B., M.D., From Instructor in Anatomy and Surgery 
to Associate in Anatomy. 

Raymond K. Thompson, B.S., M.D., From Instructor in Neuro-Surgery to 
Associate in Neuro-Surgery. 

Edward H. Stewart, Jr., M.D., From Instructor in Surgery to Associate in 
Surgery. 

Arthur Ward, M.D., From Assistant in Otolaryngology to Associate in Otolaryn- 
gology. 

Daniel Wilfson, Jr., A B., M.D., From Instructor in Medicine to Associate in 
Medicine. 

INSTRUCTORS BY PROMOTION ARE AWARDED AS FOLLOWS: 

Joseph G. Bird, A.B., M.D., From Assistant in Pharmacology and Medicine to 
Instructor in Medicine. 

John W. Chambers, M.D., From Assistant in Neuro-Surgery to Instructor in 
Neuro-Surgery. 

Maurice Feldman, Jr., A.B., M.D., From Assistant in Medicine to Instructor 
in Medicine. 

Maurice Fine, M.D., From Assistant in Medicine to Instructor in Medicine. 

Joseph E. Furnari, M.D., From Assistant in Medicine to Instructor in Medicine. 

Perry O. Futterman, A.B., M.D., From Assistant in Medicine to Instructor in 
Medicine. 

Irvin B. Kemick, B.S., Phar. G., M.D., From Assistant in Medicine to Instructor 
in Medicine. 

James J. Nolan, B.S., M.D., From Assistant in Medicine to Instructor in Medi- 
cine. 

Frank J. Otenasek, M.D., From Assistant in Neuro-Surgery to Instructor in 
Neuro-Surgery. 

Charles E. Shaw, M.D., From Assistant in Medicine to Instructor in Medicine. 

Jerome Sherman, M.D., From Assistant in Medicine to Instructor in Medicine. 

Elizabeth D. Sherrill, M.D., From Assistant in Medicine to Instructor in Medi- 
cine. 

Stuart D. Sunday, M.D., From Assistant in Medicine to Instructor in Medicine. 

Stephen J. VanLill, III, A.B., M.D., From Assistant in Medicine to Instructor 
in Medicine. 

(To Be Concluded) 



See President's Letter to Alumni for important Educational News. 



MEDICAL SCHOOL SECTION 



CANCER SEMINAR PROGRAM— 1951-1952 

(The third Wednesday in every month from 4 until 5 p.m.) 



Topic 
"Carcinoma of the Bladder" 



Dale Speaker 

October 17, 1951 Dr. Hugh J. Jewett 

Johns Hopkins Hospital 
Baltimore, Maryland 

November 14, 1951 Dr. Joseph H. Burchenal 

The Sloan-Kettering Institute for 

Cancer Research 
New York, New York 

February 20, 1952 Dr. W. U. Gardner (tentative) 

Yale University 
School of Medicine 
New Haven, Connecticut 

March 19, 1952 Dr. Alfred Blalock 

Johns Hopkins Hospital 
Baltimore, Maryland 
All lectures will be given in the Gordon Wilson Hall, University Hospital unless posted. 

ACADEMIC CALENDAR 

The Bulletin publishes herewith the Academic Calendar for the current year. This is an important 
item for reference purposes. 



"The Treatment of the Malignant 
Lymphomas" 



Experimental Ovarian and 
Lymphoid Tumorigenesis" 



"Mediastinal Tumors" 



1951 

November 20 Tuesday 

November 25 Monday 

December 21 Friday 



Academic Year — November 20, 1951 to June 7, 1952 

Instruction suspended at 5:00 P.M. 

Thanksgiving Holiday 
Instruction resumed, 8:30 A.M. 
Instruction suspended at 5:00 P.M. 

Christmas Holiday 



1952 

January 3 Thursday 

January 21 Monday 

January 26 Saturday 



Instruction resumed, 8:30 A.M. 

Midyear examinations (Senior classes continue throughout this week) 

First semester completed, 2:00 P.M. 



January 


28 


Monday 


February 


21 


Thursday 


February 


22 


Friday 


February 


23 


Saturday 


April 


10 


Thursday 


April 


15 


Tuesday 


April 


22 


Tuesday 


April 


23 


Wednesday 


May 


19 


Monday 


May 


24 


Saturday 


May 


26 


Monday 


May 


30 


Friday 


May 


31 


Saturday 


June 


7 


Saturday 



Second Semester — January 28, 1952 to June 7, 1952 
Instruction begins at 8:30 A.M. 
Instruction suspended at 5:00 P.M. 
Holiday — Washington's Birthday 
Instruction resumed 8:30 A.M. 
Instruction suspended at 5:00 P.M. 

Easter Holiday 
Instruction resumed 8:30 A.M. 
Juniors and Seniors excused to attend annual meetings of the Medical 

and Chirurgical Faculty 
Junior examinations begin 
Senior classes cease at 5:00 P.M. 
Junior examinations continue 
Sophomore and Freshman examinations begin 
Holiday — Memorial Day 
Announcement of graduates 
Commencement 
Second semester completed at 12:30 P.M. 



POST GRADUATE COMMITTEE SECTION 

POST GRADUATE COMMITTEE, SCHOOL OF MEDICINE 



Howard M. Bubert, M.D., Chairman and Director 
Elizabeth Carroll, 
Executive Secretary 

Post Graduate Office : Room 600 

29 South Greene Street 

Baltimore 1, Maryland 



Some years ago, The Faculty Board, assigned to the Post Graduate Committee 
the task of studying and endeavoring to arrive at a solution to the problem of staffing 
hospitals throughout the state of Maryland. It is the collective opinion of the Post 
Graduate Committee that this problem represents one of the most pressing needs of 
the medical facilities of the community, a need that must be satisfied at the earliest 
practicable date. A subcommittee consisting of Doctors J. Edmund Bradley, Chair- 
man; J. Morris Reese, Weatherbee Fort and D. C. Smith was appointed by the 
Chairman and Director of the Post Graduate Committee at the direction of the full 
Committee, and for many months this problem was considered and a plan made. 

This plan was incorporated in a report to the Post Graduate Committee and ap- 
proved in principle. The Post Graduate Committee realizes that this is simply a point 
of departure for further study and consideration and that a great deal of time and 
effort must be expended before an acceptable solution is found. It was the Commit- 
tee's opinion that publication of this plan would serve to arouse interest in the 
problem, and possibly, worthwhile discussion. 

Report of the Subcommittee on Hospital Survey 

Questionnaires were sent to 14 of the 16 hospitals in Baltimore City. The University 
and Johns Hopkins hospitals were excluded as the data on these were considered to 
be readily available. All questionnaires were returned. The surveyed hospitals had a 
total bed capacity of 5,095 with a daily census of 3,770 patients. There were 165,167 
patients treated in their out-patient departments and 20,225 births occurred in the 
same hospitals. There were 202 residents on duty and approval for 156 interns had 
been given these hospitals, but only 97 positions have been filled. The diagnostic 
facilities provided by the city hospitals were considered to be generally adequate; 
however, only 9 of the surveyed hospitals have facilities for therapeutic roentgenology. 
The teaching program for the residents and interns was considered to be good in ap- 
proximately one-half of the surveyed hospitals. It is to be noted, however, that the 
teaching programs made liberal use of the facilities of the University of Maryland and 
Johns Hopkins Hospitals and their respective medical schools. 

Questionnaires were also sent to 18 of the rural hospitals of Maryland, 14 of which 
have been returned to date. This represents a total of 1255 beds with a total daily cen- 



POST GRADUATE COMMITTEE SECTION ix 

sus of 751 patients. There were 6,320 births and a total of 37,079 out-patients treated. 
There were 6 rotating residents on duty in the rural hospitals, 4 of the 6 being rotating 
residents from the University of Maryland and University of Pennsylvania. Approval 
had been given, however, for a total of 10 interns, but there were no interns on duty 
in any of the rural hospitals. The diagnostic facilities in the rural hospitals showed a 
wide variation. Only 9 were equipped to do biochemical studies and only 6 to do bac- 
teriologic studies. Only 2 of the rural hospitals had a library housed in a separate 
room, and there was a combined total of 68 journals subscribed to as compared to 506 
in the city hospitals. One hospital subscribed to none and 1 to only 1 journal. Only 5 
of the rural hospitals had a medical record library and only 9 had a medical record 
librarian. Two of the rural hospitals had facilities for therapeutic roentgenology and 
3 did not even have a radiologist serving in the hospital. Teaching programs, with the 
exception of 2 of the reporting rural hospitals, were practically nonexistent. 

From this survey, it is evident that medicai training at the graduate or hospital 
level lacks uniformity. It is also suggested that the patient care rendered by the vari- 
ous hospitals in our city and state show a wide variation, a variation that clearly does 
not lend itself to the provision of equally good medical care for all. 

The medical schools of this country prepare men and women for the practice of 
medicine through reasonably standard curricula of content and duration. However, 
graduate training at the hospital level has been left almost entirely to the individual 
hospitals. This policy has resulted in unevenness in the training of graduates, despite 
strenuous efforts which have been made throughout the last 50 years by various agen- 
cies to improve the type of medical training received in these hospitals. It seems to 
the Committee that the medical school is the logical agency to plan and to direct the 
program for a uniform type of graduate training designed to prepare a man, upon 
completion of such training, for the general practice of medicine. A program under 
aegis of the medical schools should approach the problem with the understanding that 
all hospitals are potential teaching units and with the realization that development of 
this potential will result in approved training for physicians which in turn will result 
in improved medical care for the community. This subcommittee, therefore, recom- 
mends that all hospitals be considered as graduate teaching units and that steps be 
undertaken by the Director of the Post Graduate Committee of the University of 
Maryland School of Medicine to bring together the deans of the medical schools of 
the state of Maryland to utilize this teaching potential as a measure to prepare phy- 
sicians for the practice of medicine uniformly, thereby enhancing the postgraduate 
opportunities for practicing physicians and resulting in improved medical care for the 
people of Maryland. 

In the State of Maryland, a program under the direction of the two medical schools 
could be set up utilizing all the hospitals of the state and city, through provision of an 
internship of two years' duration. The reason for recommending a two years' intern- 
ship is that, in the opinion of this Committee, an internship of this duration is neces- 
sary to prepare a physician adequately for the practice of medicine. Further, it means 
that there would then be available interns for all of the hospitals throughout the city 
and state. The content of the training program should closely follow the recommenda- 
tions of various bodies that have concerned themselves with the training required to 



x BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

prepare a physician for the practice of medicine. It is suggested that the first year of 
the training program of the intern be spent in the teaching hospitals. The term "teach- 
ing hospitals" is used here to include those hospitals which would be designated as 
such by the medical school and is not restricted to the hospitals at present associated 
with the medical schools. This does not infer that the man would spend his first year 
completely and entirely in one hospital, but that he would rotate to various hospitals 
in the city and state to obtain training where it is best possible to give that training. 
For example, pediatric training might be secured in one of four institutions in the 
city that provide adequate facilities for pediatric training. The second year of the 
program would be spent in rotation as resident in general medicine in some of 
our smaller hospitals. Plans for affiliating resident training, that is, training for 
physicians at a more advanced level, is not included in this recommendation. 

The value of this type of training to the individual, to the hospital, and to the 
patient need not be elaborated upon. It becomes immediately obvious that embarking 
upon such a program would of necessity mean that all of the hospitals must be raised 
to a standard that, in the opinion of the medical schools, is conducive to good medical 
training. These standards should be arrived at through consultation of the deans of 
the medical schools and representatives of the hospitals as well as concerned educa- 
tors. It is to be unequivocally recognized that training of this type is designed to pre- 
pare men and women for the practice of medicine and does not mean that they are to 
be exploited by the various hospitals for the performance of duties that in the past, 
and even the present, are considered to be menial duties that could be performed by 
trained technicians and other trained personnel. 

The subcommittee thereby recommends the inauguration of a two-year rotating 
intern program, covering the main branches of medicine, surgery, obstetrics, gyne- 
cology, and pediatrics with standards of teaching acceptable to the deans of the 
medical schools of the State of Maryland and their consultants. 

The financing of a program of this type, in the opinion of the Committee, should 
be done through appropriations from the Maryland State Legislature. It would be 
unfair to place the financial responsibility for such a program upon the individual 
hospitals, for by doing so it would be their natural tendency to pass on the cost of this 
educational program to the patient, whereas, it is the feeling of the Committee that a 
program of this type is of value to all members of the state and should not be a penalty 
for illness or for those who utilize the facilities of a local hospital. It has been esti- 
mated roughly that a sum of 8600,000 would be adequate to finance the program 
through providing the following services, estimating that two residents could be 
assisgned to 22 rural hospitals and each received a stipend of $150 a month plus 8350 
yearly maintenance for the individual would total a sum of about 895,000. Super- 
visory services for these hospitals at $100 per month per service and estimating that 
two services need to be covered, would amount to 852,800. The total of these two 
figures for rural hospital coverage would amount to 8147,800. It is estimated that in 
the city hospitals a total of 430 residents should receive 850 monthly each which 
would total $258,000, while maintenance for these men at the same basis of 8350 
yearly would total 8150,500. Servicing of a supervisory nature, estimating that there 
would be four major services to be supervised in 16 hospitals at a cost of 850 per serv- 



POST GRADUATE COMMITTEE SECTION xi 

ice per month, would total $38,400. Thereby the total amount represented for city 
coverage would then be 84-46,900. The financing of a program through this means 
would relieve the hospital of the responsibility of supplying salaries and maintenance 
for house officers engaging in training and should mean that additional money would 
be available in the hospitals for improvement of educational facilities. 

This subcommittee thereby recommends that the financing of training medical 
graduates through a decentralized program be submitted to the Maryland State 
Legislature. 

A point of interest that needs to be considered in connection with the educational 
program as above outlined is the present policy of the Maryland State Board of Med- 
ical Examiners. At present, it is possible for a physician to practice medicine in the 
State of Maryland upon completion of a State Board examination without any 
hospital training. This, in the opinion of the subcommittee, would or might seriously 
impair the validity of any wide educational program. It seems that it would be 
necessary and desirable that the Maryland State Board of Examiners change their 
license requirements to make compulsory at least one year of hospital training before 
a physician can practice medicine in the state of Maryland. 

This subcommittee therefore recommends that the Maryland State Board of Med- 
ical' Examiners be made aware of the thinking of this Committee and that steps be 
taken to make compulsory at least one year of hospital training before a physician 
can practice medicine in the State of Maryland. 



ALUMNI ASSOCIATION SECTION 

OFFICERS 

Daniel J. Pessagno, M.D., President 

Vice-Presidents 

James Marsh, M.D. William E. Lennon, M.D. Harry L. Rogers, M.D. 

Simon Brager, M.D., Secretary Edwin H. Stewart, Jr., M.D., Assistant Secretary 

Minette E. Scott, Executive Secretary Thurston R. Adams, M.D., Treasurer 

Board of Directors 
Louis A. M. Krause, M.D. 

Chairman 



Daniel J. Pessagno, M.D. 
Thurston R. Adams, M.D. 
Simon Brager, M.D. 
Edwin H. Stewart, Jr., M.D. 
Wetherbee Fort, M.D. 
Albert E. Goldstein, M.D. 
Thomas K. Galvin, M.D. 
William H. Triplett, M.D. 
George H. Yeager, M.D. 

Louis H. Douglass, M.D. 



Hospital Council 
Alfred T. Gundry, M.D. 
George F Sargent, M.D. 

Nominating Committee 
Robert F. Healy, M.D., 

Chairman 
Ernest I. Cornprooks, M.D. 
Frank K. Morris, M.D. 
David Tenner, M.D. 
Arthur Siwinski, M.D. 

Alumni Council 



Library Committee 
Milton S. Sacks, M.D. 
Representatives to General Alumni 

Board 
John A. Wagner, M.D. 
Thurston R. Adams, M.D. 
William H. Triplett, M.D. 
Representatives, Editorial Board, 

Bulletin 
Harry C. Hull, M.D. 
Albert E. Goldstein, M.D. 
Daniel J. Pessagno, M.D. 

(ex- officio) 
Lewis P. Gundry, M.D. 



The names listed above are officers for the term beginning July 1, 1951 and ending June 30, 1952. 



PRESIDENT'S LETTER 

Enrollments in the 72 approved medical schools of the United States have expanded 
greatly. At the end of 1950, physicians in the continental United States totaled 
202,040, the largest number on record. The combined freshman class for 1950-51 
reached an all time high of more than 7,000. Never before have there been so many 
students preparing to enter the field of medicine. It has been estimated that in 1960 
there will be an increase of 30 per cent more physicians graduating than in 1950. 
Failure to maintain our present high standards in medical education would be dis- 
astrous to the future of medical care. 

The medical schools are facing major financial problems today with higher opera- 
tional costs, inflation and lower income from endowments. Individual large bene- 
factions are few. We must have additional financial support if we are to continue to 
serve the American people with a greater supply of well-trained physicians. The 
financing of medical education should be a major concern to all. 

This needed support must not come from the federal government for that would 
only mean a relaxation of our efforts in our constant fight against the socialization of 
medicine. It is the belief of the American Medical Association that support should 
come from private sources which are far from exhausted. Once the need is brought to 
the attention of the medical profession and laymen, especially those who recognize the 
value of the medical schools' contribution to society, we can continue to secure the 
needed funds from voluntary sources. However, the primary responsibility in securing 
these funds falls on each one of us. 



ALUMNI ASSOCIATION SECTION 




The National Fund for Medical Education was established on May 16, 1951. It is 
sponsored by outstanding leaders from the fields of public affairs, business, industry, 
agriculture, labor, higher education, the American Medical Association and the 
Association of American Medical Colleges. Former president Herbert Hoover is the 
honorary chairman of its board of 66 trustees. The purpose of this organization of lay- 
men is to raise funds by private subscrip- 
tion to forestall any attempt of the federal 
government to assume support of medical 
schools. 

The American Medical Education Foun- 
dation has been chartered as a not-for-profit 
corporation under the laws of the State of 
Illinois to provide an instrument whereby 
physicians and state and county medical 
societies can make their contributions to the 
National Fund. One hundred per cent is 
contributed with nothing deducted for ex- 
penses. 

In addition to making their own contribu- 
tions physicians can render invaluable serv- 
ice by encouraging officers of companies and 
corporations of their acquaintance to con- 
tribute to the fund. If the medical profes- 
sion will lead the way, others will follow. 
Individuals and corporation officials who 
object to government subsidy of medical education surely share the responsibility 
of producing other income. 

The American Medical Association estimates that if every member of the medical 
profession were to make an average yearly contribution of $100, nearly $18,000,000 
in new income would be provided. 

I am urging each member of the alumni to send his contribution to the American 
Medical Education Foundation, 535 N. Dearborn St., Chicago-10, Illinois. Provision 
has been made in arrangements between the Foundation and the Fund for handling 
any special requests so that contributions may be allocated to any particular school 
designated by the contributor. 

The funds collected will be distributed to all approved medical schools for un- 
restricted use, each institution being entirely free to determine how best to utilize 
its share in medical training. 

Daniel J. Pessagno, M.D., President 

ALUMNI DAY, 1951 

Registration at the annual Alumni Day activities again represented an unusual 
degree of enthusiasm as noted among the many out-of-town Alumni returning for this 
occasion. Approximately 200 were present at the clinical session and annual luncheon 
with over 400 attending the banquet given in honor of the class of 1951. 



Dr. D. J. Pessagno 

Photo : Fabian Bachrach 



xiv BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 

The Scientific session included two clinical pathologic conferences and a clinical 
demonstration of "The Surgical Relief of Hemiballismus" by Drs. George Smith and 
Richard Coblentz. Following the customary luncheon, the annual business meeting 
of the Medical Alumni Association was held. After the usual reports of the Officers 
and Committees, Dr. William H. Triplett read the Necrology. The Treasurer reported 
a net balance, after expenditures, of $6,375.70. 

Dr. Christopher C. Shaw then spoke of a recent trip to Japan and suggested that 
the Alumni Association sponsor an exchange fellowship. 



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Dr. Louis A. M. Krause presents the Alumni Honor Award to Dr. George E. Bennett 

Dr. Joseph J. Bowen suggested that some fitting memorial be erected to the Alumni 
who lost their lives in World War II. The subject of these two items will be discussed 
at the next meeting of the Board of Directors and will be published in a forthcoming 
issue of the Bulletin. 

Dr. George E. Bennett, Professor Emeritus of Orthopedics at the Johns Hopkins 
School of Medicine and a member of the class of 1909, was then introduced as the 
principal speaker. Dr. Bennett spoke on "Reminiscences of the Class and Faculty of 
1909." Following his address, Dr. Bennett was presented with the annual Alumni 
Honor Award, a scroll and a gold key, by Dr. Louis A. M. Krause, President of the 
Alumni Association. As the ceremonies closed, the President read a most interesting 
telegram addressed to Dr. Bennett from Dr. John S. Norman of King's Mountain, 



ALU MX I ASSOCIATION SECTION xv 

North Carolina, a classmate. "To him who triumphs may the laurel victory be your 
crown and the coming years you shall climb upward to greater heights on the ladder 
of fame viewed by men who honor your efforts and hope for you an Eden of peace and 
joy forever, God willing. My love to all the boys." 



ALUMNUS CONTRIBUTES FIRST CHECK TO AMERICAN MEDICAL 
EDUCATION FOUNDATION 

Dr. Robert H. Dreher, class of 1934, who practices in Wind Gap, Pennsylvania, 
was the first American physician to contribute to the American Medical Education 
Foundation. As an alumnus of the School of 
Medicine, his action typifies the interest, 
leadership and loyalty for which due recog- 
nition and acknowledgement should cer- 
tainly follow. 

Other alumni of the . School of Medicine 
have already contributed to the Foundation 
for the year 1951. Acknowledgement of 
these contributions will be published as soon 
as the completed list is available. 

If you have not as yet contributed, your 
check should be mailed without delay to the 
American Medical Education Foundation, 
535 North Dearborn Street, Chicago 10. 
You may request that your contribution be 
turned over in its entirety to the School of 
Medicine. Remember, your entire dollar 
goes for medical education unfettered. The Dr - R - H. Dreher 

American Medical Association and the endowments of the National Fund for Medi- 
cal Education, the dispensing agency, assume the administrative costs. 

Contributions are deductible for income tax purposes. 




The University of Maryland is first — keep it there. See School News. 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



REGISTRANTS ON ALUMNI DAY 
1886 

R. Sumter Griffith 



1895 



Thomas W. Keown 

1897 

Lucius N. Glenn 



J. A. Baer 

Benjamin H. Dorsey 
Norman S. Dudley 
Charles T. Fisher 
Campbell Flautt 
Frank A. Glantz 



1904 

Charles Bagley, Jr. 



Louis H. Douglass 
William T. Gocke 
J. J. Greengrass 
John F. Hogan 
Frank L. Jennings 
F. H. Hutchinson 
Robert E. S. Kelly 



Albert E. Goldstein 
Philip J. Bean 
James W. Katzenberger 
Louise A. M. Kraus 



Louis C. Dobihal 
F. A. Holden 



Nicholas G. Wilson 



1898 

Page Edmunds 



1901 



James McClung 
John B. McMurray 
William T. Messmore 
R. Gibson Perry, Sr. 
William R. Rogers 
Arthur Vanderbeek 
Virgil G. Williams 



1906 

Arnold D. Tuttle 



1909 

George E. Bennett 
Harry M. Robinson, Sr. 



1911 



Joseph B. Kilbourn 
B. L. Symkowski 
J. E. Springer 
William H. Triplett 
Ralph J. Vreeland 
Louis V. Williams 
Caldwell Woodruff 



1912 



H. Boyd Wylie 



1913 



Charles Reid Edwards 



1914 



John F. Lutz 



1917 

Lawrence H. Wheeler 

1920 

George C. Medairy 
William J. B. Orr 
J. Morris Reese 



ALUMNI ASSOCIATION SECTION 



1921 



Bruce Barnes 
C. F. Fisher 
Daniel Keegan 
Francis A. Reynolds 



E. Martinez-Rivera 
J. S. Schilling 
Felix Shubert 
H. E. Wangler 



George A. Knipp 



M. Paul Byerly 



Harry Anker 
John Askin 
Margaret Ballard 
Irvin Bronsten 
Elias Diamond 
Abel Gordon 
David Helfond 
Louis Lavy 
Joseph Levin 
H. Edmund Levin 
Frank Lusby 



Nelson Carey 

Byruth Lenson-Lambros 



1922 

Joseph Stovin 



1923 



Karl J. Myers 



1925 

Leo T. Brown 

1926 

Emanuel Manginelli 
Albert Moriconi 
William C.- Polsue 
Albert Rosenberg 
Abraham Rothberg 
David Sashin 
Jacob Schmuckler 
Elizabeth Sherman 
E. V. Teagarden 
Maurice Teitelbaum 
Samuel Weinstein 
Louis Weseley 

1927 

A. H. Finkelstein 
Frank K. Morris 
Herbert E. Reifschneider 



1929 

George H. Yeager 



1930 



Kenneth L. Benfer 



M. Ray Hannum 
K. M. Hornbrook 
Page Jett 
Walter J. Keefe 
H. V. Langeluttig 
D. G. Mankovich 



John C. Dumler 
Harrv C. Hull 



Emil Hildenbrand 



1931 



Waldo Moyers 
Christopher C. Shaw 
Arthur G. Siwinski 
Michael Skovron 
Alexander Slavcoff 
Robert B. Taylor 



1932 



Samuel E. Proctor 
John E. Savage 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 



Thurston R. Adams 



1934 



Milton S. Sacks 



Ernest I. Cornbrooks, Jr. 



William Greifinger 
C. Henry Jones 
Walter E. Karfgin 



Everett S. Diggs 
D. Frank Kaltreider 
Ephraim T. Lisansky 



Louis C. Gareis 
Robert C. Sheppard 



Raymond M. Cunningham 



Edmund G. Beacham 



J. A. Arnett 
Charles P. Barnett 
Joseph J. Bowen 
J. Culpepper Brooks 
William L. Bundick 
Pierson M. Checket 



Van B. Bennett 
Joseph G. Bird 



Robert M. N. Crosby 
David B. Gray 
John S. Haught 



J. Carlton Godlove 
Henry J. Holljes 



1935 

Howard B. Mays 
Karl F. Mech 

1936 

Eugene R. McNich 
M. J. Nicholson 
S. D. Pentecoste 
Gibson J. Wells 



1937 



Joseph E. Muse, Jr. 
Samuel T. Revell, Jr. 
C. Parke Scarborough 



J. King B. E. Seegar 



1938 



John A. Wagner 
Theodore E. Woodward 



1939 



Dexter Reimann 



1940 



W. H. Townshend, Jr. 



1941 

Felix R. Morris 
Frank S. Renna 
Benedict Skitarelic 
H. R. Spinnler 
Edwin F. Wilson 
Kazuo Yanagisawa 

1942 

Joseph Furnari 
Theodore Kardash 
E. Roderick Shipley 

1943 

DeVoe K. Meade 
Alfred T. Nelson 
Edwin H. Stewart, Jr. 
Stephen Van Lill 



1944 



Charles E. Shaw, Jr. 
F. X. Paul Tinker 



ALUMNI ASSOCIATION SECTION 



Thomas G. Barnes 
Sarah Cook 



Jerome E. Cohn 
Paul E. Frye 
John Gamble, Jr. 
Harry W. Gray 
Charles W. Hawkins 

Arlie R. Maneberger, Jr. 

John R. Hankins 
Frederick J. Heldrich, Jr. 

Charles T. Henderson 

Charles Bagley, III 
Mary V. Barstow 



1945 

James R. McNich 
S. Malone Parham 
John J. Tansey 



1946 



Jerome D. Nataro 
Pomeroy Nichols. Jr. 
E. Milton Smith 
Edward P. Smith, Jr. 
Joseph B. Workman 



1947 



Wallace H. Mitchell 



1948 



H. Patterson Mack 
William S. Womack 



1949 



John F. Strahan 



1950 



Francis J. Borges 
S. W. Henson, Jr. 




Plates of the School of Medicine, University of Maryland, the New Hospital, and the 
Old Hospital are available. These white plates are 10 inches in diameter with black print. 
The price is $2.50 each, plus 25 cents insurance and postage. Send order, stating the plates 
desired, with check to Mrs. Bessie M. Arnurius, Box 123, University Hospital, Baltimore, 
Maryland. Make check payable to Nurses Alumnae Association of the University op 
Maryland. 



ALUMNI DAY HIGHLIGHTS 




Dr. William Rogers and Dr. Arnold D. Tuttle chat at luncheon. (Top) 

(Dr. Tuttle died Oct. 6, 1951— Ed.) 
Dr. A. H. Finkelstein and Dr. Abel Gordon talk it over. (Center) 
Dr. Earl Springer of Akron, Ohio. (Bottom L.) 
Dr. Thomas W. Keown, class of 1895, B.M.C. (Bottom R.) 



ALUMNI ASSOCIATION SECTION 
ALUMNI DAY HIGHLIGHTS 





^- " ^0^.,, 



*" 



Dr. Louis A. M. Krause addresses the annual meeting. (Top) 

A threesome. Drs. William J. B. Orr, Lucius Glenn, and Page Edmunds. (Center) 

Registration desk. 

1 to r — Dr. H. Edmund Levin, and Dr. Page Edmunds. (Bottom) 



BULLETIN OF THE SCHOOL OF MEDICINE, U. OF MD. 




Class of 1921 (Top) 
L to r— C. F. Fisher, F. S. Shubert, F. A. Reynolds, Louis Lass, H. E. Wangler, J. M. Schilling. 

Class of 1946 (Center) 

Front row, 1 to r— John R. Gamble, Harry Gray, Jerome Xataro, E. Milton Smith, Jr. Back row, 
1 to r — Joseph Workman, Edward P. Smith, Jr., Paul Frey. 

Class oj 1941 (Bottom) 

Front row, 1 to r— Jerome C. Arnett, J. Culpepper Brooks, Jr., William R. Bundick, Felix R. 
Morris. Back row, 1 to r— Joseph J. Bowen, Francis S. Renna, Pierson M. Checket, Benedict' Skita- 
relic. 




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BULLETIN 



OF THE 



SCHOOL of MEDICINE 

UNIVERSITY OF MARYLAND 
September, 195 1 




Announcements for 



The One Hundred Forty-Sixth Academic Session 
1951-1952 



Catalogue of 

The One Hundred Forty-Fifth Academic Session 

1950-1951 



CALENDAR 



1951 


1952 


1953 


JULY 


JANUARY 


JULY 


JANUARY 


s 


M 


T 


W 


T 


F 


S 


S 


M 


T 


W 


T 


F 


S 


S 


M 


T 


w 


T 


F 


S 


S 


M 


T 


VV 


T 


F 


S 


1 


2 


3 


4 


5 


6 


7 






1 


2 


3 


4 


5 






1 


2 


3 


4 


5 










1 


2 


3 


8 


9 


10 


11 


12 


13 


14 


6 


7 


8 


9 


10 


11 


12 


6 


7 


8 


9 


10 


11 


12 


4 


5 


6 


7 


8 


9 


10 


15 


!o 


17 


18 


19 


20 


21 


13 


14 


15 


16 


17 


18 


19 


13 


14 


15 


16 


17 


IS 


19 


11 


12 


15 


14 


15 


16 


17 


22 


23 


24 


25 


26 


27 


28 


20 


21 


22 


23 


24 


25 


26 


20 


21 


22 


23 


24 


25 


20 


IS 


19 


20 


21 


22 


23 


24 


29 


30 


31 










27 


2S 


29 


30 


31 






27 


28 


29 


30 


31 






25 


20 


27 


28 


29 


30 


31 


AUGUST 




FEBRUARY 


AUGUST 


FEBRUARY 


S 


M 


T 


VV 


T 


F 


S 


S 


M 


T 


w 


T 


F 


S 


S 


M 


T 


VV 


T 


F 


S 


S 


M 


T 


VV 


T| F 


S 








1 


2 


3 


4 












1 


2 












1 


2 


1 


2 


5 


4 


5 


6 


7 


5 


6 


7 


8 


9 


10 


11 


3 


4 


5 


6 


7 


8 


9 


3 


4 


5 


6 


7 


8 


9 


8 


9 


10 


11 


12 


15 


14 


12 


13 


14 


15 


16 


17 


18 


10 


11 


12 


13 


14 


15 


16 


10 


11 


12 


13 


14 


15 


10 


15 


10 


17 


IS 


19 


20 


21 


19 


20 


21 


22 


23 


24 


25 


17 


IS 


19 


20 


21 


22 


23 


17 


18 


19 


20 


21 


22 


23 


22 


23 


24 


25 


26 


27 


28 


26 


11 


28 


29 


30 


31 




24 


25 


26 


27 


28 


29 




24 
31 


25 


26 


27 


2S 


29 


30 












































SEPTEMBER 


MARCH 


SEPTEMBER 


MARCH 


S 


M 


T 


W 


T 


F 


S 


S 


M 


T 


W 


T 


F 


S 


S 


M 


T 


VV 


T 


F 


S 


S 


M 


T 


VV 


T 


F 


S 














1 
8 


2 


3 


4 


5 


6 


1 


1 
8 


"i 


1 
8 


2 
9 


3 

10 


4 

11 


5 

12 



13 


1 
8 


2 
9 


3 
10 


4 
11 


5 
12 


6 
15 


7 
14 


2 


3 


4 


5 


() 


7 


9 


10 


11 


12 


13 


14 


15 


9 


10 


11 


12 


13 


14 


15 


14 


15 


16 


17 


IS 


19 


20 


15 


10 


17 


18 


19 


20 


21 


16 


17 


IS 


19 


20 


21 


22 


16 


17 


IS 


19 


20 


21 


22 


21 


22 


23 


24 


25 


20 


27 


22 


23 


24 


25 


26 


27 


28 


23 


24 


25 


26 


27 


28 


29 


23 


24 


25 


26 


27 


28 


29 


28 


29 


30 










29 


30 


51 










30 














30 


31 






































OCTOBER 


APRIL 


OCTOBER 


APRIL 


S 


M 


T 


W 


T 


F 


S 


S 


M 


T 


VV 


T 


F 


S 


S 


M 


T 


VV 


T 


F 


S 


S 


M 


T 


VV 


T 


F 


S 




1 


2 


3 


4 


5 


6 






1 


2 


3 


4 


5 








1 


2 


3 


4 








1 


2 


3 


4 


7 


8 


9 


10 


11 


12 


13 


6 


7 


8 


9 


10 


11 


12 


5 


6 


7 


8 


9 


10 


11 


5 


6 


7 


8 


9 


10 


11 


14 


15 


16 


17 


IS 


19 


20 


13 


14 


15 


16 


17 


18 


19 


12 


13 


14 


15 


16 


17 


18 


12 


13 


14 


15 


16 


17 


18 


21 


22 


23 


24 


25 


20 


27 


20 


21 


22 


23 


24 


25 


26 


19 


20 


21 


22 


23 


24 


25 


19 


20 


21 


22 


23 


24 


25 


28 


29 


30 


31 








27 


28 


29 


30 








26 


27 


28 


29 


30 


31 




26 


27 


28 


29 


30 






NOVEMBER 


MAY 


NOVEMBER 


MAY 


S 


M 


T 


VV 


T 


F 


S 


S 


M 


T 


W 


T 


F 


S 


S 


M 


T 


W 


T 


F 


S 


S 


M 


T 


VV 


T 


F 


S 










1 
8 


2 

9 


3 
10 


4 


5 


6 


7 


1 

8 


2 
9 


3 
10 


2 


3 


4 


5 





"7 


1 

8 












1 

8 


2 
9 


4 


5 


6 


7 


3 


4 


5 


6 


7 


11 


12 


13 


14 


15 


16 


17 


11 


12 


13 


14 


15 


16 


17 


9 


10 


11 


12 


13 


14 


15 


10 


11 


12 


13 


14 


15 


16 


18 


19 


20 


21 


22 


23 


24 


18 


19 


20 


21 


22 


23 


24 


16 


17 


18 


19 


20 


21 


22 


17 


18 


19 


20 


21 


22 


23 


25 


26 


27 


28 


29 


30 




25 


26 


27 


28 


29 


30 


31 


23 
30 


24 


25 


26 


27 


28 


29 


24 
31 


25 


26 


27 


28 


29 


30 


DECEMBER 


JUNE 


DECEMBER 


JUNE 


S 


M 


T 


VV 


T 


F 


S 


S 


M 


T 


VV 


T 


F 


S 


s 


M 


T 


VV 


T 


F 


S 


S 


M 


T 


VV 


T 


F 


S 














1 


1 


2 


3 


4 


5 


6 


7 




1 


2 


3 


4 


5 


6 




1 


2 


3 


4 


5 


6 


2 


3 


4 


5 


6 


7 


8 


8 


9 


10 


11 


12 


13 


14 


7 


8 


9 


10 


11 


12 


15 


7 


8 


9 


10 


11 


12 


13 


9 


10 


11 


12 


13 


14 


15 


15 


16 


17 


IS 


19 


20 


21 


14 


15 


10 


17 


18 


19 


20 


14 


15 


16 


17 


18 


19 


20 


16 


17 


18 


19 


20 


21 


22 


22 


23 


24 


25 


26 


27 


28 


21 


22 


23 


24 


25 


20 


27 


21 


22 


23 


24 


25 


26 


27 


23 


24 


25 


26 


27 


28 


29 


29 


30 












28 


29 


50 


31 








28 


29 


50 










30 


31 









































































CALENDAR 

Academic Year — September 20, 1951 to June 7, 1952 



1951 






September 


10, 


11, 12 




FIRST SEME 


September 


18 


Tuesday 


September 


19 


Wednesday 


September 


20 


Thursday 


November 


20 


Tuesday 


November 26 


Monday 


December 


21 


Friday 


1952 






January 


3 


Thursday 


January- 


21 
to 


Monday 


January 


26 


Saturday 


January 


28 


Monday 


February 


21 


Thursday 


February 


22 


Friday 


February 


23 


Saturday 


April 


10 


Thursday 


April 


15 


Tuesday 


April 


22 


Tuesday 


April 


23 


Wednesday 


May 


19 


Monday 


May 


24 


Saturday 


May 


26 


Monday 


May 


30 


Friday 


May 


31 


Saturday 


June 


7 


Saturday 



Re-examinations for advancement 
FIRST SEMESTER— September 20, 1951 to January 26, 1952 

*Registration, payment of fees, freshmen & sophomores 
*Registration, payment of fees, all other students 
Instruction begins at 8:30 a.m. 
Instruction suspended at 5:00 p.m. 

Thanksgiving Holiday 
Instruction resumed 
Instruction suspended at 5:00 p.m. 
Christmas Holiday 

Instruction resumed 
Midyear examinations 
*Payment of fees for second semester 
First semester completed, 2:00 p.m. 

SEMESTER— January 28 to June 7, 1952 

Instruction begins at 8:30 a.m. 
Instruction suspended at 5:00 p.m. 
Holiday — Washington's Birthday 
Instruction resumed 
Instruction suspended at 5:00 p.m. 

Easter Holiday 
Instruction resumed 
Juniors and Seniors excused to attend annual meetings 

of the Medical & Chirurgical Faculty 
Junior examinations begin 
Senior classes cease at 5 :00 p.m. 
Junior examinations continue 
Sophomore and Freshman examinations begin 
Holiday — Memorial Day 
Announcement of graduates 
Commencement 
Second Semester completed at 12:30 p.m. 

PARTIAL CALENDAR FOR 1952-1953 



1952 
September 8, 9, 10 
September 16 Tuesday 
September 17 Wednesday 
September 18 Thursday 



Re-examinations for advancement 
"Registration, payment of fees, freshmen & sophomores 
N Registration, payment of fees, all other students 

Instruction begins at 8:30 a.m. 



* A student who fails to register prior to or within the day or days specified will be 
called upon to pay a late registration fee of five dollars ($5.00) . The last day of registra- 
tion with fee added to regular charges is Saturday of the week in which registration begins. 

The offices of the registrar and comptroller are open daily from 9:00 A.M. to 4:00 P.M., 
and Saturday from 9:00 A.M. to 12:00 noon. 

5 



ORGANIZATION 

THE UNIVERSITY OF MARYLAND 

Harry Clifton Byrd, B.S., LL.D., D.Sc, President and Executive Officer 
BOARD OF REAGENTS 

Term Expires 

William P. Cole, Jr., Chairman Baltimore 1958 

Stanford Z. Rothschild, Secretary Baltimore 1952 

J. Milton Patterson, Treasurer Baltimore 1953 

B. Herbert Brown, Jr Baltimore 1960 

Edward F. Holter Middletown 1959 

E. Paul Knotts Denton 1954 

Arthur O. Lovejoy Baltimore 1960 

Charles P. McCormick Baltimore 1957 

Harry H. Nuttle Denton 1957 

Philip C. Turner Parkton 1959 

Mrs. John L. Whitehurst Baltimore 1956 

Members of the Board are appointed by the Governor of the State for terms of 
nine years each, beginning the first Monday in June. 

The President of the University of Maryland is, by law, Executive Officer of the 
Board. 

A regular meeting of the Board is held the third Friday in each month, except 
during the months of July and August. 

Each school has its own Advisory Board, Council, or Committee composed of 
the Dean and members of its faculty, which controls the internal affairs of the 
group it represents. 

The University has the following educational organizations: 



At Baltimore 

The School of Dentistry 
The School of Law 
The School of Medicine 
The School of Nursing 
The School of Pharmacy 
The College of Education 
(Baltimore Division) 

At College Park 

The College of Agriculture 

The College of Arts and Sciences 



The College of Business and Public 
Administration 

The College of Education 

The Glenn L. Martin College of 
Engineering and Aeronautical 
Sciences 

The College of Home Economics 

The Graduate School 

The College of Military Science 

The College of Physical Education, 
Recreation and Health 

The College of Special and Con- 
tinuation Studies 

The Summer School 



ADMINISTRATIVE OFFICERS 

School of Medicine 

H. C. Byrd, B.S., LL.D., D.Sc President of the University 

H. Boyd Wylie, M.D Dean 

Alma H. Preinkert, MA Registrar 

Edgar F. Long, Ph.D Director of Admissions 

7 



SCHOOL 0/ MEDICINE 

FACULTY OF MEDICINE 
EMERITI 

J. M. H. Rowland, M.D., D.Sc, LL.D. 

Professor of Obstetrics, Emeritus; Dean, Emeritus 

Henry J. Walton, M.D Professor of Roentgenology, Emeritus 

Page Edmunds, M.D Professor of Traumatic Surgery, Emeritus 

Ruth Lee Briscoe Librarian, Emeritus 

Albertus Cotton, M.A., M.D.. Professor of Orthopaedic Surgery, and Roentgenology, 

Emeritus 5 

Harvey G. Beck, M.D., D.Sc Professor of Clinical Medicine, Emeritus 

Irving J. Spear, M.D Professor of Neurology, Emeritus 

Carl L. Davis, M.D Professor of Anatomy, Emeritus 

Arthur M. Shipley, M.D., D.Sc Professor of Surgery, Emeritus 

Clyde A. Clapp, M.D Professor of Ophthalmology, Emeritus 

Andrew C. Gillis, M.A., M.D., LL.D Professor of Neurology, Emeritus 

Edgar B. Friedenwald, M.D Professor of Clinical Pediatrics, Emeritus 

ADVISORY BOARD OF THE FACULTY 



Dean H. Boyd Wylie, Chairman 

0. G. Harne, Secretary 

George H. Buck, Ex Officio Member 



William R. Amberson 
James G. Arnold, Jr. 
Walter A. Baetjer 
Charles Bagley, Jr. 
J. Edmund Bradley 
Otto C. Brantigan 
Raymond M. Burgison 
Howard M. Bubert 
T. Nelson Carey 
C. Jelleff Carr 
Thomas R. Chambers 
Carl Dame Clarke 
Richard G. Coblentz 
Beverley C. Compton 
Charles N. Davidson 
John DeCarlo. Jr. 
Louis H. Douglass 
C. Redd Edwards 
Monte Edwards 



Frederick P. Ferguson 
Frank H. J. Figge 
Jacob E. Finesinger 
A. H. Finkelstein 
Moses Gellman 
Gordon E. Gibbs 
Frank W. Hachtel 
Edward J. Herbst 
Cyrus F. Horine 
Harry C. Hull 
J. Mason Hundley, Jr. 
Elliott H. Hutchins 
Edward S. Johnson 
F. L. Jennings 
Frank D. Kaltreider 
James R. Karns 
Walter L. Kilby 
Edward A. Kitlowski 
F. Edwin Knowles 



Vernon E. Krahl 
John C. Krantz, Jr. 
Louis A. M. Krause 
Kenneth D. Legge 
R. W. Locher 
Edward A. Looper 
William S. Love, Jr. 
John F. Lutz 
Charles W. Maxson 
Zachariah Morgan 
Theodore H. Morrison 
Alfred T. Nelson 
H. Whitman Newell 
Thomas R. O'Rourk 

C. W. Peake 

D. J. Pessagno 
H. R. Peters 
Maurice C. Pincoffs 
J. Morris Reese 



5 Died May 3, 1951. 



SCHOOL OF MEDICINE 



Charles A. 

Reifschneider 
Dexter L. Reimann 
Harry M. Robinson, Sr. 
Harry L. Rogers 
Milton S. Sacks 
Emil G. Schmidt 
Andrew G. Smith 
Dietrich C. Smith 
Frederick B. Smith 



William H. Smith 
Hugh R. Spencer 
Thomas P. Sprunt 
Edward Steers 
W. Houston Toulson 
J. McCullough Turner 
Eduard Uhlenhuth 
Henry F. Ullrich 
Raymond E. Vanderlinde 
Allen F. Voshell 



John A. Wagner 
Grant E. Ward 
C. Gardner Warner 
Huntington Williams 
Walter D. Wise 
Theodore E. Woodward 
Thomas C. Wolff 
Robert B. Wright 
George H. Yeager 
Waitman F. Zinn 



ADVISORY COMMITTEE OF THE FACULTY 



William R. Amberson 
J. Edmund Bradley 
Louis H. Douglass 
C. Reid Edwards 
Jacob E. Finesinger 
Frank W. Hachtel 



O. G. Harne, Assistant 
to the Dean, Secretary 
J. Mason Hundley 
Walter L. Kilby 
F. Edwin Knowles, Jr. 
John C. Krantz, Jr. 



Alfred T. Nelson 
Maurice C. Pincoffs 
Emil G. Schmidt 
Hugh R. Spencer 
Eduard Uhlenhuth 
H. Boyd Wylie, Dean 
Chairman 



FACULTY OF MEDICINE 
PROFESSORS 

Myron S. Aisenberg, D.D.S., Professor of Pathology, School of Dentistry. 

William R. Amberson, Ph.D., Professor of Physiology, and Head of the Department. 

Charles Bagley, Jr., M.A., M.D., Professor of Neurological Surgery. 

Joseph C. Biddix, Jr., D.D.S., Professor of Oral Diagnosis, School of Dentistry. 

J. Edmund Bradley, M.D., Professor of Pediatrics, and Head of the Department. 

Otto C. Brantigan, B.S., M.D., Professor of Surgical Anatomy, Clinical and Thoracic 

Surgery. 
T. Nelson Carey, M.D., Professor of Clinical Medicine. 
C. Jelleff Carr, Ph.D., Professor of Pharmacology. 2 

Richard G. Coblentz, M.A., M.D., Professor of Clinical Neurological Surgery. 
Edward C. Dobbs, D.D.S., Professor of Pharmacology, School of Dentistry. 
Brice M. Dorsey, D.D.S., Professor of Oral Surgery, School of Dentistry. 
Louis H. Douglass, M.D., Professor of Obstetrics, and Head of the Department. 

It is to be noted that for convenience of reference the names of the mem- 
bers of the Faculty are listed in the forepart of this catalogue in alphabetical 
order. The names are listed in order of seniority under each preclinical and 
clinical department of the school on subsequent pages. 

On the lists of the Faculty of Medicine and Fellows and the Hospital and Dispensary 
staffs are given the names and positions assigned during the period July 1, 1951 to June 30. 
1952 unless otherwise indicated. Changes are noted as follows: 

1 Appointments effective July 1, 1951. 

2 Promotions effective July 1, 1951. 

3 Resignations. 

4 Retirements. 
6 Deaths. 

6 Leave of absence. 



10 UNIVERSITY OF MARYLAND 

Charles Reid Edwards, M.D., Professor of Surgery, and Acting Head of the Department. 

Monte Edwards, M.D., Clinical Professor of Surgery and Professor of Proctology. 

Ray Ehrensberger, Ph.D., Professor of Speech, College of Arts and Sciences. 

Lloyd D. Felton, A.B., D.Sc, M.D., Visiting Research Professor of Bacteriology. 1 

Frank H. J. Figge, Ph.D., Professor of Anatomy. 

Jacob E. Finesinger, M.D., Professor of Psychiatry, and Head of the Department. 

Grason W. Gaver, D.D.S., Professor of Dental Prosthetics, School of Dentistry. 

Frank W. Hachtel, M.D., Professor of Bacteriology, and Head of the Department. 

Harry C. Hull, M.D., Professor of Clinical Surgery. 

J. Mason Hundley, Jr., M.A., M.D., Professor of Gynecology, and Head of the Department. 

Elliott H. Hutchins, M.A., M.D., Professor of Surgery. 

F. L. Jennings, M.D., Professor of Clinical Surgery. 

C. Loring Joslin, M.D., Professor of Pediatrics. 

Walter L. Kilby, M.D., Professor of Roentgenology, and Head of the Department. 

Edward A. Kitlowski, A.B., M.D., Clinical Professor of Plastic Surgery. 

John C. Krantz, Jr., Ph.D., D.Sc, Professor of Pharmacology, and Head of the Depart- 
ment. 

Louis A. M. Krause, M.D., Professor of Clinical Medicine. 

Kenneth D. Legge, M.D., Professor of Clinical Urology. 

Edward A. Looper, M.D., D.Oph., Professor of Otolaryngology, and Head of the Depart- 
ment. 

Theodore H. Morrison, M.D., Clinical Professor of Gastro-Enterology. 

Alfred T. Nelson, M.D., Professor of Anaesthesiology, and Head of the Department. 

Ernest B. Nuttall, D.D.S., Professor of Crown and Bridge, School of Dentistry. 

Thomas R. O'Rourk, M.D., Professor of Otolaryngology. 

D. J. Pessagno, A.B., M.D., Professor of Clinical Surgery 

H. Raymond Peters, A.B., M.D., Professor of Clinical Medicine 

Maurice C. Pincoffs, B.S., M.D., Professor of Medicine, and Head of the Department. 

Kyrle W. Preis, D.D.S., Professor of Orthodontics, School of Dentistry. 1 

Kenneth V. Randolph, D.D.S., Professor of Operative Dentistry, School of Dentistry. 

Charles A. Reifschneider, M.D., Clinical Professor of Traumatic Surgery. 

John R. Reid, Ph.D., Visiting Professor of Psychiatry. 1 " 

Harry L. Rogers, M.D., Clinical Professor of Orthopaedic Surgery. 

Harry M. Robinson, Sr., M.D., Professor of Dermatology. 

Emil G. Schmidt, Ph.D., LL.B., Professor of Biological Chemistry, and Head of the De- 
partment. 

Dietrich Conrad Smith, Ph.D., Professor of Physiology. 

Hugh R. Spencer, M.D., Professor of Pathology, and Head of the Department. 

Thomas P. Sprunt, A.B., M.D., Professor of Clinical Medicine. 

W. Houston Toulson, M.Sc, M.D., Professor of Urology. 

I. Ridgeway Trimble, M.D., Professor of Clinical Surgery. 2 

Eduard Uhlenhuth, Ph.D., Professor of Anatomy, and Head of the Department. 

Allen Fiske Voshell, A.B., M.D., Professor of Orthopaedic Surgery. 

Huntington Williams, M.D., Dr. P.H., Professor of Hygiene and Public Health. 

Walter D. Wise, M.D., Professor of Surgery. 

George H. Yeager, B.S., M.D., Professor of Clinical Surgery, and Director of Clinical 
Research. 

Waitman F. Zinn, M.D., Professor of Otolaryngology. 

la Appointment effective Sept. 1, 1950 



SCHOOL OF MEDICINE 11 

ASSOCIATE PROFESSORS 

Franklin R. Anderson, M.D., Associate Professor of Otolaryngology. 5 

Merle Ansberry, Ph.D., Associate Professor of Speech, College of Arts and Sciences. 

James G. Arnold, Jr., M.D., Associate Professor of Neurological Surgery. 

H. M. Bubert, M.D., Associate Professor of Medicine. 

Thomas R. Chambers, A.B., M.D., Associate Professor of Surgery. 

Carl Dame Clarke, Associate Professor of Art as Applied to Medicine. 

Charles N. Davidson, M.D., Associate Professor of Roentgenology. 

Ross Davies, M.D., Associate Professor of Hygiene and Public Health. 

J. S. Eastland, M.D., Associate Professor of Medicine. 

A. H. Finkelstein, M.D., Associate Professor of Pediatrics. 

Russel S. Fisher, M.D., Associate Professor of Legal Medicine. 1 

Leon Freedom, M.D., Associate Professor of Neurology. 

Frederick P. Furguson, Ph.D., Associate Professor of Physiology. 2 

William L. Garlick, A.B., M.D., Associate Professor of Thoracic Surgery and Associate 

in Surgery. 2 
Moses Gellman, B.S., M.D., Associate Professor of Orthopaedic Surgery. 
Gordon E. Gibbs, M.D., Associate Professor of Clinical Research. 1 
Lewis P. Gundry, M.D., Associate Professor of Medicine. 
O. G Harne, Associate Professor of Anatomy, and Asst. to the Dean. 
Hugh H. Hicks, D.D.S., Associate Professor of Periodontology, School of Dentistry. 
Cyrus F. Horine, M.D., Associate Professor of Surgery. 
Albert Jaffe, M.D., Associate Clinical Professor of Pediatrics. 
Edward S. Johnson, M.D., Associate Professor of Surgery. 
VVedon Johnson, A.B., M.D., Associate Professor of Anesthesiology. 1 
D. Frank Kaltreider, A.B., M.D., Associate Professor of Obstetrics. 2 
Fayne A. Kayser, M.D., Associate Professor of Otolaryngology. 
Vernon E. Krahl, B.S., M.S., Ph.D., Associate Professor of Anatomy. 
Frederick T. Kyper, M.D., D.Sc, Associate Professor of Otolaryngology. 
R. W. Locher, M.D., Associate Professor of Clinical Surgery. 
William S. Love, Jr., A.B., M.D., Associate Professor of Medicine. 
Charles W. Maxson, M.D., Associate Professor of Surgery. 
Walter C. Merkel, A.B., M.D., Associate Professor of Pathology. 
Samuel Morrison, A.B., M.D., Associate Professor of Medicine, Associate Professor of 

Gastro-enterology. 
James W. Nelson, M.D., Associate Professor of Surgery. 
H. Whitman Newell, M.D., Associate Professor of Psychiatry. 
C. W. Peake, M.D., Associate Professor of Surgery. 
J. Morris Reese, M.D., Associate Professor of Obstetrics. 
Dexter L. Reimann, B. S., M.D., Associate Professor of Pathology. 
Benjamine S. Rich, A.B., M.D., Associate Professor of Otolaryngology. 
Ida M. Robinson, A.B., B.S.L.S., Associate Professor of Library Science. 
Milton S. Sacks, M.D., Associate Professor of Medicine and Head of Clinical Pathology, 

Associate in Pathology. 
Frederick B. Smith, M.D., Associate Professor of Pediatrics. 
William H. Smith, M.D., Associate Professor of Clinical Medicine. 
Edward Steers, Ph.D., Associate Professor of Bacteriology. 
Lewis C. Toomey, D.D.S., Associate Professor of Oral Surgery, School of Dentistry. 

5 Died Jan. 23, 1951. 



12 UNIVERSITY OF MARYLAND 

J. McCullough Turner, Ph.D., Associate Professor of Physiology. 2 

Henry F. Ullrich, M.D., D.Sc, Associate Professor of Orthopaedic Surgery 

John A. Wagner, B.S., M.D., Associate Professor of Pathology. 

W. Wallace Walker, M.D., Associate Professor of Surgery and Surgical Anatomy. 

Grant E. Ward, A.B., M.D., Associate Professor of Surgery and Oral Surgery. 3 

C. Gardner Warner, A.B., M.D., Associate Professor of Pathology. 

William H. F. Warthen, A.B., M.D., Associate Professor of Hygiene & Public Health. 

T. Conrad Wolff, M.D., Associate Professor of Medicine, and Head of the Division of 

Physical Diagnosis. 
Theodore E. Woodward, M.D., Associate Professor of Medicine 
Robert B. Wright, B.S., M.D., Associate Professor of Pathology. 

ASSISTANT PROFESSORS 

Thurston R. Adams, M.D., Assistant Professor of Surgery and Proctology. 

Donald J. Barnett, M.D., Assistant Professor of Roentgenology. 

H. F. Bongardt, M.D., Assistant Professor of Surgery. 

Leo Brady, A.B., M.D., Assistant Professor of Gynecology. 

Simon H. Brager, M.D., Assistant Professor of Surgery and Proctology. 

Raymond M. Burgison, Ph.D., Assistant Professor of Pharmacology. 1 * 

Beverley C. Compton, A.B., M.D., Assistant Professor of Gynecology. 

Ernest I. Cornbrooks, Jr., A.B., M.D., Assistant Professor of Gynecology. 

Edward F. Cotter, M.D., Assistant Professor of Medicine, Associate in Neurology. 

J. G. N. Cushing, M.D., Assistant Professor of Psychiatry. 

John DeCarlo, A.B., M.D., Assistant Professor of Roentgenology. 

William K. Diehl, M.D., Assistant Professor of Gynecology. 

Everett S. Diggs, B.S., M.D., Assistant Professor of Gynecology. 

John S. Dumler, B.S. ; M.D., Assistant Professor of Gynecology. 

William W. Elgin, M.D., Assistant Professor of Psychiatry. 

Francis A. Ellis, A.B., M.D., Assistant Professor of Dermatology. 

Maurice Feldman, M.D., Assistant Professor of Gastro-Enterology. 

Jerome Fineman, M.D., Assistant Professor of Pediatrics. 

Wetherbee Fort, M.D., Assistant Professor of Medicine. 

Frank J. Geraghty, A.B., M.D., Assistant Professor of Medicine. 

Francis W. Gillis, M.D., Assistant Professor of Urology. 

Samuel S. Glick, M.D., Assistant Professor of Pediatrics. 

Albert E. Goldstein, M.D., Assistant Professor of Pathology. 

George Govatos, A.B., M.D., Assistant Professor of Surgery. 

Robert G. Grenell, B.A., M.Sc, Ph.D., Assistant Professor Psychiatric Research. 2 

Edward J. Herbst, Ph.D., Assistant Professor of Biological Chemistry. 

John F. Hogan, M.D., Assistant Professor of Urology. 

F. Edwin Knowles, Jr., M.D., Assistant Professor of Ophthalmology and Chairman 
of the Department. 

H. Vernon Langeluttig, M.D., Assistant Professor of Medicine. 

C. Edward Leach, M.D., Assistant Professor of Medicine. 

Philip L. Lerner, M.D., Assistant Professor of Neurology. 

Ephriam T. Lisansky, M.D., Assistant Professor of Medicine and Associate in Psy- 
chiatry. 2 

Hans W. Loewald, M.D., Assistant Professor of Psychiatry. 

la Appointment effective Sept., 1, 1950. 



SCHOOL OF MEDICINE 13 

John F. Lutz, A.B., M.D., Assistant Professor of Anatomy. 

Henry J. L. Marriott, A.M., B.M., Assistant Professor of Medicine. 

Howard B. Mays, M.D., Assistant Professor of Genito-Urinary Surgery and Instructor in 

Urology and Pathology. 
W. Raymond McKenzie, M.D., Assistant Professor of Otolaryngology. 
Karl F. Meek, B.S., M.D., Assistant Professor of Anatomy. 2 
Zachariah Morgan, M.D., Assistant Professor of Gastro-Enterology. 
Hugh B. McNally, B.S., M.D., Assistant Professor of Obstetrics. 
Harry M. Murdock, B.S., M.D., Assistant Professor of Psychiatry. 
George McLean, M.D., Assistant Professor of Medicine. 
M. Alexander Novey, A.B., M.D., Assistant Professor of Obstetrics. 
Samuel T. R. Revell, Jr., M.D., Assistant Professor of Medicine. 
I. O. Ridgely, M.S., M.D., Assistant Professor of Surgery. 
William F. Rienhoff, M.D., Assistant Professor of Surgery. 
Robert A. Reiter, M.D., Assistant Professor of Medicine. 2 
Harry M. Robinson, Jr., B.S., M.D., Assistant Professor of Dermatology, Associate in 

Medicine. 
Irving Rothchild, Ph.D., Assistant Professor of Physiology. 
John E. Savage, B.S., M.D., Assistant Professor of Obstetrics. 
Kathyrn L. Schultz, M.D., Assistant Professor of Psychiatry. 
Theodore A. Schwartz, M.D., Assistant Professor of Otolaryngology. 
William M. Seabold, M.D., Assistant Professor of Pediatrics. 

William B. Settle, M.D., Assistant Professor of Surgical Anatomyand Associate in Surgery. 
Isadore A. Siegel, A.B., M.D., Assistant Professor of Obstetrics. 
Arthur G. Siwinski, A.B., M.D., Assistant Professor of Surgery. 2 
Andrew G. Smith, Ph.D., Assistant Professor of Bacteriology. 
Edward P. Smith, M.D., Ph.G., Assistant Professor of Gynecology. 
Sol Smith, M.D., Assistant Professor of Medicine. 
Isidore William Towlen, M.D., Assistant Professor of Anesthesiology. 
Raymond E. Vanderlinde, A.B., Ph.D., Assistant Professor of Biological Chemistry. 
Philip S. Wagner, M.D., Assistant Professor of Psychiatry. 
Gibson J. Wells, M.D., Assistant Professor of Pediatrics. 
Milton J. Wilder, M.D., Assistant Professor of Orthopedic Surgery. 

ASSOCIATES 

Conrad B. Acton, M.D., Associate in Medicine. 
Marie A. Andersch, Ph.D., Associate in Medicine. 
Leon Ashman, B.S., M.D., Associate in Medicine. 2 
J. Tyler Baker, B.S., M.D., Associate in Obstetrics. 
Margaret B. Ballard, M.D., Associate in Obstetrics. 
Charles P. Barnett, A.B., M.D., Associate in Pathology. 
Edmund G. Beacham, M.D., Associate in Medicine. 
Eugene S. Bereston, A.B., M.D., Associate in Dermatology. 
Robert Z. Berry, A.B., M.D., Associate in Otolaryngology. 2 
Louis V. Blum, M.D., Associate in Medicine. 2 
Harry C. Bowie, B.S., M.D., Associate in Surgical Anatomy. 
Kenneth B. Boyd, A.B., M.D., Associate in Gynecology. 
Frank J. Brady, M.D., Associate in Anaesthesiology. 
Henry A. Briele, M.D., Associate in Postgraduate Surgery. 1 
V. V. Brunst, Sc.D., Research Associate in Anatomy. 



14 UNIVERSITY OF MARYLAND 

William R. Bundick, M.D., Associate in Dermatology. 2 

Harold H. Burns, M.D., Associate in Surgery. 

M. Paul Byerly, M.D., Associate in Medicine. 

Richard A. Carey, M.D., Associate in Medicine. 

Osborne D. Christensen, M.D., Associate in Obstetrics. 

Jonas Cohen, M.D., Associate in Medicine. 2 

Edward R. Dana, A.B., M.D., Associate in Roentgenology. 

Kathryn Dice, Ed.D., Associate in Clinical Psychology. 

Francis G. Dickey, M.D., Associate in Medicine. 

D. McClelland Dixon, M.D., Associate in Obstetrics and Instructor in Pathology. 

Stanley H. Durlacher, M.D., Associate in Legal Medicine. 

J. J. Erwin, M.D., Associate in Gynecology. 

L. K. Fargo, M.D., Associate in Urology. 

William L. Fearing, M.D., Associate in Neurology. 3 

Donald E. Fisher, M.D., Associate in Pathology. 

William H. Fisher, M.D., Associate in Postgraduate Surgery. 1 

Irving Freeman, M.D., Associate in Medicine. 

Henry C. Freimuth, Ph.D., Associate in Legal Medicine. 

John S. Haines, M.D., 2 Associate in Urology. 

Alvin J. Hartz, A.B., M.D., Associate in Medicine. 

Raymond F. Helfrich, A.B., M.D., Associate in Surgery. 

W. Grafton Herspberger, M.D., Associate in Medicine. 

John T. Hibbitts, M.D., Associate in Gynecology. 

Henry W. D. Holljes, M.D., Associate in Medicine. 

Z. Vance Hooper, M.D., Associate in Gastro-Enterology. 

Clewell Howell, B.S., M.D., Associate in Pediatrics. 

Benjamin H. Isaacs, A.B., M.D., Associate in Otolaryngology. 

Meyer W. Jacobson, M.D., Associate in Medicine. 

Joseph V. Jerardi, B.S., M.D., Associate in Surgery. 

Hugh J. Jewett, M.D., Associate in Urology. 

Arthur Karfgin, B.S., M.D., Associate in Medicine. 

Walter Karfgin, M.D., Associate in Medicine. 

James R. Karns, B.S., M.D., Associate in Medicine, and Physician in Charge of Medical 

Care of Medical Students. 2 
Joseph I. Kemler, M.D., Associate in Ophthalmology. 
Albert W. Kitts, M.D., Associate in Postgraduate Pediatrics. 10 
Louis B. Kroll, A.B., M.D., Associate in Medicine. 2 
Elizabeth LaForge, M.S.S., Associate in Psychiatric Social Work. 
Samuel Legum, M.D., Associate in Medicine. 
H. Edmund Levin, M.D., Associate in Bacteriology. 
Kurt Levy. M.D., Associate in Medicine. 

William B. Long, M.D., Associate in Postgraduate Surgery. 1 
H. Patterson Mack, M.D., Associate in Anatomy. 2 
G. Bowers Mansdorfer, B.S., M.D., Associate in Pediatrics. 
I. H. Maseritz, M.D., Associate in Orthopaedic Surgery. 
William J. McClafferty, M.D., Associate in Legal Medicine. lb 
George G. Merrill, M.D., Associate in Neurology. 
Moritz Michaelis, Ph.D., Research Associate in Psychiatry. 18 

Effective appointment dates: Associates 
^Nov. 1, 1950. 
lb Jan. 25, 1951. 

lc Jan. 5, 1951. 



SCHOOL OF MEDICINE 15 

Lyle J. Millan, M.D., Associate in Urology. 
Frank K. Morris, A.B., M.D., Associate in Gynecology. 
J. Huff Morrison, B.S., M.D., Associate in Obstetrics. 2 
S. Edwin Muller, M.D., Associate in Medicine. 
Patrick C. Phelan, Jr., A.B., M.D., Associate in Anatomy. 2 

Ross Z. Pierpont, M.D., Associate in Surgical Anatomy, and Assistant in Surgery. 
Herbert E. Reifschneider, A.B., M.D., Associate in Surgery and Surgical Anatomy. 
R. C. V. Robinson, M.D., Associate in Dermatology. 
Sidney Scherlis, M.D., Associate in Medicine. 
William M. Seabold, A.B., M.D., Associate in Pediatrics. 
Lawrence M. Serra, M.D., Associate in Medicine. 
A. Albert Shapiro, B.S., M.D., Associate in Dermatology. 
Benedict Skitarelic, A.B., M.D., Associate in Pathology. 
Edward H. Stewart, Jr., M.D., Associate in Surgery. 2 
Harry A. Teitlebaum, B.S., M.D., Ph.D., Associate in Neurology. 

Raymond K. Thompson, B.S., M.D., Associate in Neurosurgery, and Director of Neuro- 
logical Research. 2 
Wilfred H. Townshend, Jr., A.B., M.D., Associate in Medicine. 
Isadore Tuerk, M.D., Associate in Psychiatry. 
William K. Waller, M.D., Associate in Medicine. 
Arthur Ward, M.D., Associate in Otolaryngology. 2 
Daniel Wilfson, Jr., A.B., M.D., Associate in Medicine. 2 
Austin H. Wood, M.D., Associate in Urology. 
Israel Zeligman, A.B., M.D., Associate in Dermatology. 

LECTURERS 

Harold E. Himwich, M.D., Lecturer in Physiology and Psychiatry. 1 * 

Amedeo S. Marrazzi, M.D., Lecturer in Pharmacology. 

Joseph M. Miller, M.D., Lecturer in Surgery. 

William H. Summerson, Ph.D., Lecturer in Biological Chemistry. 

INSTRUCTORS 

A. Russell Anderson, M.D., Instructor in Psychiatry. 

Robert E. Bauer, A.B., M.D., Instructor in Medicine. 

Harry McB. Beck, M.D., Instructor in Gynecology, and Assistant in Obstetrics. 1 

Joseph G. Bird, A.B., M.D., Instructor in Medicine. 2 

Thomas S. Bowyer, A.B., M.D., Instructor in Gynecology and Assistant in Obstetrics. 

John T. Bracken, B.S., M.D., Instructor in Roentgenology. lb 

Charles E. Brambel, A.M., Ph.D., Instructor in Medicine. 

George H. Brouillet, B.S., M.D., Instructor in Surgery. 

Ann Virginia Brown, A.B., Instructor in Biological Chemistry. 

J. E. Brumback Jr., B.S., M.D., Instructor in Ophthalmology. 

William J. Bryson, A.B., M.D., Instructor in Pathology. 

Lucile J. Caldwell, M.D., Instructor in Dermatology. 

Enoch Calloway, Jr., A.B., M.D., Instructor in Psychiatry. 

Joseph P. Cappuccio, D.D.S., Instructor in Oral Surgery, School of Dentistry. 

John W. Chambers, M.D., Instructor in Neurosurgery, Assistant in Surgery. 2 

Effective appointment date: Lecturers. 
18 Nov. 1, 1950. 

Effective appointment date: Instructors. 
lb Dec. 1,1950. 



16 UNIVERSITY OF MARYLAND 

Thomas A. Christensen, A.B., M.D., Instructor in Pediatrics. 

Morris M. Cohen, M.D., Instructor in Dermatology. 

Joseph M. Cordi, M.D., Instructor in Pediatrics. 

Richard J. Cross, B.S., M.D., Instructor in Ophthalmology, and Otolaryngology. 6 

Raymond M. Cunningham, A.B., M.D., Instructor in Anatomy and Proctology, Assistant 
in Surgery. 

George H. Davis, B.S., M.D., Instructor in Obstetrics. 2 

John R. Davis, M.D., Instructor in Medicine. 

W. Allen Deckert, A.B., M.D., Instructor in Gynecology and Assistant in Surgery. 

John B. DeHoff, M.D., Instructor in Medicine. 

John M. Dennis, B.S., M.D., Instructor in Roentgenology. 1 

William A. Dodd, M.D., Instructor in Gynecology, and Assistant in Obstetrics. 

Charles H. Doeller, Jr., A.B., M.D., Instructor in Gynecology, and Assistant in Obstetrics. 

William C. Duffy, A.B., M.D., Instructor in Gynecology. 

Ernest S. Edlow, A.B., M.D., Instructor in Gynecology. 

Maurice Feldman, Jr., A.B., M.D., Instructor in Medicine. 2 

Maurice Fine, M.D., Instructor in Medicine. 2 

Philip D. Flynn, M.D., Instructor in Medicine. 

Samuel L. Fox, Ph.G., B.S., M.D., Instructor in Physiology, and Associate in Otolaryn- 
gology. 

Paul N. Friedman, A.B., M.D., Instructor in Ophthalmology. 

Audry M. Funk, A.B., Instructor in Medicine. 

Joseph E. Furnari, M.D., Instructor in Medicine. 2 

Perry O. Futterman, A.B., M.D., Instructor in Medicine. 

L. Calvin Gareis, B.S., M.D., Instructor in Pathology, and Obstetrics, Assistant in 
Gynecology. 

Jason H. Gaskel, M.D., Instructor in Orthopaedic Surgery. 

H. L. Granoff, A.B., M.D., Instructor in Gynecology. 

Isaac Gutman, Instructor in Orthopaedic Surgery. 

Samuel J. Hankin, M.D. Instructor in Medicine. 

Charles W. Hawkins, M.D., Instructor in Anatomy. 6 

Mary L. Hayleck, M.D., Instructor in Pediatrics. 

Robert F. Healy, M.D., Instructor in Surgery. 

Donald B. Hebb, M.D., Instructor in Proctology and Assistant in Surgery. 

William G. Helfrich, B.S., M.D., Instructor in Medicine. 

L. Ann Hellen, B.S., Instructor in Medicine. 

Mark B. Hollander, A.B., M.D., Instructor in Dermatology and Syphilology. 

Calvin Hyman, M.D., Instructor in Surgery. 

Conrad L. Inman, D.D.S., Instructor in Anesthesiology, School of Dentistry. 

Marshall I. Kacler, D.D.S., Instructor in Oral Surgery, School of Dentistry. 

Edward S. Kallins, B.S., M.D., Instructor in Medicine. 

William H. Kammer, Jr., A.B., M.D., Instructor in Medicine. 

Harry F. Kane, M.D., Instructor in Gynecology. 

Theodore Kardash, B.S., M.D., Instructor in Gynecology and Pathology. 

Clyde F. Karns, B.S., M.D., Instructor in Surgery. 

Irvin B. Kemick, B.S., Ph.G., M.D., Instructor in Medicine. 2 

Leon A. Kochman, M.D., Instructor in Medicine. 

Schuyler G. Kohl, B.S., M.D., Instructor in Obstetrics. 

Edward L. J. Kreig, M.D., Instructor in Pathology. 1 

A. Kremen, A.B., M.D., Instructor in Ophthalmology. 

Arnold F. Lavenstein, Instructor in Pediatrics. 

Algert P. Lazauskas, D.D.S., Instructor in Oral Surgery, School of Dentistry. 



SCHOOL OF MEDICINE 17 

V. Harwood Link, M.D., Instructor in Dermatology. 
F. Ford Loker, B.S., M.D., Instructor in Surgery. 
Helen I. Maginnis, M.D., Instructor in Gynecology. 

Louis O. J. Manganiello, A.B., M.D., Instructor in Anatomy, 1 Research Fellow, Neuro- 
surgery. 3 
Charles B. Marek, M.D., Instructor in Gynecology. 
Marion W. Mathews, A.B., M.S., M.D., Instructor in Psychiatry. 
Robert E. McCafferty, B.S., M.S., M.D., Instructor in Anatomy. 18 
Francis J. McLaughlin, M.D., Instructor in Psychiatry. 

D. J. McHenry, B.S., M.D., Instructor in Ophthalmology. 6 

Jose" Medina, D.D.S., Instructor in Oral Surgery, School of Dentistry. 

Israel P. Meranski, B.S., M.D., Instructor in Pediatrics. 

James P. Miller, M.D., Instructor in Orthopaedic Surgery. 10 

J. Duer Moores, B.S., M.D., Instructor in Surgery. 

Joseph E. Muse, Jr., B.S., M.D., Instructor in Medicine. 

Ruth Musser, M.S., Instructor in Pharmacology. 

John A. Myers, M.E.E., M.D., Instructor in Medicine, Assistant in Gastro-Enterolngy. 

James J. Nolan, B.S., M.D., Instructor in Medicine. 2 

Samuel Novey, M.D., Instructor in Psychiatry. 

Frank J. Otenasek, M.D., Instructor in Neuro-Surgery. 2 

Robert T. Parker, A.B., M.D., Instructor in Medicine. 1 

Samuel E. Proctor, A.B., M.D., Instructor in Surgery. 

J. Emmett Queen, M.D., Instructor in Medicine. 

Martin A. Robbins, M.D., Instructor in Urology. 1 

Daniel R. Robinson, M.D., Instructor in Surgery. 

Seymour W. Rubin, M.D., Instructor in Pathology. 

William J. Rysanek, Jr., M.D., Instructor in Gynecology. 

Clarence P. Scarborough, M.D., Instructor in Surgery. 

John F. Schaefer, B.S., M.D., Instructor in Surgery. 

J. King B. E. Seegar, Jr., A.B., M.D., Instructor in Obstetrics. 

Charles E. Shaw, M.D., Instructor in Medicine. 2 

Joseph C. Sheehan, B.S., M.D., Instructor in Gynecology 6 

Robert C. Sheppard, M.D., Instructor in Surgery. 

Jerome Sherman, M.D., Instructor in Medicine. 2 

Elizabeth D. Sherrill, M.D., Instructor in Medicine. 2 

E. Roderick Shipley, A.B., M.D., Instructor in Surgery. 
Albert J. Shochat, B.S., M.D., Instructor in Gastro-Enterology. 

George W. Smith, B.S., M.D., Instructor in Anatomy, Assistant in Neuro-Surgery. 1 

Ruby A. Smith, B.S., M.D., Instructor in Ophthalmology. 

Merrill J. Snyder, B.S., Instructor in Bacteriology. 

Melchijah Spragins, B.S., M.D., Instructor in Pediatrics. 

Stuart D. Sunday, M.D., Instructor in Medicine. 2 

William T. Supik, M.D., Instructor in Proctology. 

Robert B. Tunney, A.B., M.D., Instructor in Gynecology. 

Roy B. Turner, B.S., M.D., Instructor in Pathology, 1 and Neuro-Anatomy. ld 

William D. VandeGrift, M.D., Instructor in Pathology. 

Effective appointment dates: Instructors. 

18 Appointment Effective Aug. 1, 1951. 

3 Resigned April 30, 1951. 

lc Oct. 5, 1950. 

ld Feb. 1, to June 1, 1951. 



18 UNIVERSITY OF MARYLAND 

Edmond G. Vanden Bosche, D.D.S., Instructor in Oral Surgery, School of Dentistry. 

Stephen J. Van Lill, III, A.B., M.D., Instructor in Medicine. 2 

Frederick J. Vollmer, B.S., M.D., Instructor in Medicine. 

Gladys E. Wadsworth, B.S., M.A., Instructor in Anatomy. ld 

Charles Herman Williams, M.D., Instructor in Medicine. 1 

Frederick S. Wolf, M.D., Instructor in Neurology. le 

John D. Young, Jr., M.D., Instructor in Urology. 1 

ASSISTANTS 

Robert C. Abrams, M.D., Assistant in Orthopaedic Surgery. 10 

Fred B. Agee, M.D., Assistant in Medicine. 1 

Jose A. Alvarez, M.D., Assistant in Neurological Surgery. 

A. Maynard Bacon, Jr., B.S., M.D., Assistant in Pediatrics. 6 

Ruth W. Baldwin, M.D., Assistant in Pediatrics and Director of the Pediatrics Seizure 

clinic. 1 
Thomas G. Barnes, M.D., Assistant in Surgery. 1 
Harry McB. Beck, A.B., M.D., Assistant in Obstetrics. 
Walter J. Benavent, B.S., M.D., Assistant in Plastic Surgery. 
Harold P. Biehl, M.D., Assistant in Surgery. 1 
Jane L. Bleakley, Assistant in Art as Applied to Medicine. 
Jenifred S. Boehm, A.B., Assistant in Art as Applied to Medicine. 
Melvin M. Borden, M.D., Assistant in Pediatrics. 1 
Frances C. Brown, A.B., Assistant in Physiology. 
A. V. Buchness, A.B., M.D., Assistant in Surgery. 
Bernard Burgin, A.B., M.D., Assistant in Medicine. 1 
Lester H. Caplan, M.D., Assistant in Pediatrics. 
L. T. Chance, M.D., Assistant in Surgery. 
James N. Cianos, M.D., Assistant in Surgery. 
Raymond J. Clayton, Jr., Assistant in Art as Applied to Medicine. 
Harry Cohen, B.S., M.D., Assistant in Obstetrics and Pathology. 1 
Sarah Cook, A.B., M.D., Assistant Director Post Graduate Medicine, and Assistant in 

Pediatrics. 
Donald D. Cooper, M.D., Assistant in Pediatrics. 3 
R. Adams Cowley, M.D., Assistant in Thoracic Surgery and Assistant Director Surgical 

Research. 1 
Samuel H. Culver, M.D., Assistant in Surgery. 

Martha Curtis, B.S., R.N., Assistant and Assistant Director, Medical Care Clinic. le 
E. Hollister Davis, A.B., M.D., Assistant in Anaesthesia. 
Patricia Dawson, Assistant in Art as Applied to Medicine. 3 
Michael L. DeVincentis, B.S., M.D., Assistant in Surgery. 
William A. Dodd, B.S., M.D., Assistant in Obstetrics.' 
William C. Dunnigan, A.B., M.D., Assistant in Surgery. 

Effective appointment dates: Instructors. 

ld Oct. 1, 1950— June 30, 1951 

le Sept. 15, 1950. 

Effective appointment dates; Assistants. 

lc Oct. 1, 1950. 

^Jan. 1,1951. 



SCHOOL OF MEDICINE 19 

Shirley K. Fitzgerald, Assistant in Art as Applied to Medicine. 18 

William N. Fitzpatrick, B.S., M.D., Assistant in Psychiatry. 

Marjorie R. Fleitzer, M.S.S., Assistant in Psychiatric Social Work. lc 

Joseph B. Ganey, M.D., Assistant in Surgery. 1 

Richard M. Garrett, M.D., Assistant in Surgery and Surgical Anatomy. 1 

William R. Geraghty, B.S., M.D., Assistant in Surgery. 

Marvin Goldstein, A.B., M.D., Assistant in Medicine. 1 

Caridad E. Gonzalez, M.D., Assistant in Pediatrics. 3 

Howard Goodman, M.D., Assistant in Pediatrics. 1 

Donald B. Hebb, A.B., M.D., Assistant in Thoracic Surgery. 1 

John H. Hirschfeld, M.D., Assistant in Otolaryngology. 

Hermione Hunt Hawkins, M.A., Assistant in Clinical Psychology . ld 

Sylvia Himmelfarb, A.B., Assistant in Physiology. 

John V. Hopkins, M.D., Assistant in Orthopaedic Surgery. 

Rollin C. Hudson, M.D., Assistant in Medicine. 

Henry K. Jarrett, M.D., Assistant in Urology. 1 

Everett D. Jones, M.D., Assistant in Orthopaedic Surgery. 

Arthur Kandel, M.S., Assistant in Clinical Psychology. 16 

Vernon C. Kelley, A.B., M.D., Assistant in Obstetrics. lb 

Lauriston L. Keown, M.D., Assistant in Medicine. 

Irvin P. Klemkowski, B.S., M.D., Assistant in Obstetrics. 

Raymond M. Lauer, M.D., Assistant in Medicine. 1 

Alfred S. Lederman, Assistant in Gastro-Enterology. 

Lee R. Lerman, M.D., Assistant in Dermatology. 1 

Frank E. Leslie, A.B., M.D., Assistant in Medicine. 

Berton V. Lock, M.D., Assistant in Medicine. 1 

William D. Lynn, A.B., M.D., Assistant in Surgery and Assistant Director Surgical 

Research. 3 
W. Kenneth Mansfield, Jr., M.D., Assistant in Obstetrics. 
Clarence W. Martin, M.D., Assistant in Obstetrics. 
Howard B. McElwain, M.D., Assistant in Surgery. 
Donald W. Mintzer, M.D., Assistant in Medicine. 1 
Carl A. Myers, A.B., M.D., Assistant in Medicine. 1 
Joseph C. Myers, M.D., Assistant in Medicine. 1 
Pomeroy Nichols, Jr., M.D., Assistant in Neurological Surgery. 
John C. Osborne, M.D., Assistant in Medicine. 
John C. Ozazewski, M.D., Assistant in Ophthalmology. 1 
Ross Z. Pierpont, M.D., Assistant in Surgery. 
Susan R. Pincoffs, R.N., Assistant in Medicine. 
Hazel Y. Pruitt, Assistant in Bacteriology. 3 
Jeanne Ann Quinlin, A.B., Assistant in Physiology. 111 
James H. Ramsey, M.D., Assistant in Pathology. 1 

Effective appointment dates; Assistants. 

18 Feb. 26, 1951. 

lb Feb. 1, 1951. 

10 Oct. 1,1950. 

ld Nov. 1,1950. 

16 Jan. 1, 1951. 

lh Sept. 16, 1951. 



20 UNIVERSITY OF MARYLAND 

James Russo, M.D., Assistant in Anaesthesiology. 

O. Walter Spurrier, M.D., Assistant in Pediatrics. 

Vesta May Stevens, M.S.S., Assistant in Psychiatric Social Work. lf 

Thomas McClelland Stevenson, Assistant in Art as Applied to Medicine. 

T. J. Touhey, M.D., Assistant in Surgery. 

William Earl Weeks, M.D., Assistant in Pediatrics. 

Jack Wexler, A.B., M.D., Assistant in Medicine. 

J. Carlton Wich, B.S., M.D., Assistant in Pediatrics. 

Marcella Wiseman, M.S.S., Assistant in Psychiatric Social Work. 

Geraldine F. Wolfe, B.S., M.S., Assistant in Anatomy. 1 * 

Thomas Worsley, M.D., Assistant in Medicine. 

Howard L. Zupnik, M.D., Assistant in Surgery. 

FELLOWS 

Charles P. Barnett, A.B., M.D., Baltimore Rh Typing Laboratory Fellow in Medicine. 1 

Frederick K. Bell, Ph.D., Fellow in Pharmacology. 

George W. Bradford, M.D., Baltimore Rh Laboratory, Fellow in Medicine. 

Leonard S. Brahen, B.S., M.S., Eli Lilly Fellow in Pharmacology 11 - 

James S. Browne, M.D., Fellow in Neurosurgery. 

Robert S. Cato, A.B., M.D., Fellow in Roentgenology. 6 

Robert M. N. Crosby, M.D., Fellow in Neuro. Surgery. 6 

Ruth Page Edwards, A. B., A. M. Ph.D., Fellow in Psychology. 1 ' 

Richard F. C. Egan, M.S., John F. B. Weaver Fellow in Physiology. 1 

Frank A. Faraino, B.S., M.D., Fellow in Thoracic Surgery. 

Mary S. Fassel, A.B., Fellow in Pharmacology. 

Martin K. Gorten, M.D., Baltimore Rh Typing Laboratory Fellow in Medicine. 1 

John B. Harmon, B.S., Emerson Fellow in Pharmacology. 

Dorothy H. Hubbard, A.B., M.S., Research Corporation Fellow in Biological Chemistry. 1 

Dewitt T. Hunter, John F. B. Weaver Fellow in Anatomy. 

Marvin Jaffee, M.D., Fellow in Psychiatry. lb 

Theodore Kardash, B.S., M.D., Research Fellow in Gynecological Pathology. 10 

Frederick Go-Kiatsu, B.S., M.D., Fellow in Pediatrics. 

Gerald Kessler, B.S., Nutrition Foundation Fellow in Biological Chemistry. 1 

Robert G. Leonard, B.S., M.S., Bressler Reserved Fund Fellow in Biological Chemistry. 11 

Johnson S. L. Ling, A.B., M.S., Eli Lilly Fellow in Pharmacology. 1 ' 

William E. Loechel, U. S. Public Health Fellow in Medical Art. ld 

Go Lu, M.D., Fellow in Pharmacology. lk 

Louis 0. J. Manganiello, A.B., M.D., Fellow in Neurosurgery. 3 

Arlie R. Mansberger, Jr., M.D., Research Fellow in Surgery. 

Eugene R. McNinch, M.D., Fellow in Roentgenology. 1 " 

Effective appointment date: Assistants. 

lf Sept. 15, 1950. 

••Feb. 1, 1951. 

Effective appointment dates; Fellows. 

lb Sept. 15, 1950. 

lc May 1, to Aug. 31, 1951. 

ld Oct. 1, 1950 to Sept. 30, 1951. 

^Nov. 1,1951. 

11 Sept. 1, 1951. 

lk Sept. 1, 1951 to Aug. 31, 1952. 



SCHOOL OF MEDICINE 21 

A. Gibson Packard, A.B., John F, B. Weaver Fellow in Anatomy. 1 * 

Sim Penton, M.D., Fellow in Thoracic Surgery. 1 ' 

Gerardo B. Polanco, M.D., National Cancer Institute Traieee in Pathology. 1 

J. Pomeroy Nichols, M.D., Fellow in Neurological Surgery. 

James H. Shell, B.S., M.D., Hitchcock Fellow in Gynecology. 1 

George W. Smith, M.D., Hitchcock Fellow in Neurosurgery. 1 

Thomas A. Stebbins, A.B., Medical Illustrator in Gynecology. 

Virginia Suttonfield, M.D., Fellow in Psychiatry. 16 

Edward B. Truitt, B.S., Fellow American Foundation for Pharmaceutical Education. 1 

Roy B. Turner, M.D., Fellow in Neurosurgery. 111 

Robert T. Walker, M.D., Fellow in Medicine. 

Annemarie Weber, U.S.P.H., Fellow in Physiology. 1 * 1 

John I. White, Ph.D., U.S.P.H., Fellow in Physiology. lb 

Joseph B. Workman, A. B., M.D., Research Fellow in Medicine. 1 

CONSULTANTS 

Robert W. Swain, B.S., Consultant in Radiologic Physics. la 

RESEARCH ASSISTANTS 

Maryanne E. Berger, Research Assistant in Anatomv. 1 

Richard E. Brown, B.S., Research Assistant in Bacteriology. 1 

Catherine S. Brunst, A.B., Research Assistant in Anatomy. 

Betty J. Fax, Ph.D., Research Assistant in Psychiatry. lb 

Eleanor G. B. Glinos, A.B., Research Assistant in Biological Chemistry. 1 " 1 

William McKendre Headley, B.S. Research Assistant in Neurosurgery. 11 

Carolyn F. Hendrickson, B.S., Research Assistant in Physiology. ld 

Earnest C. Herrmann, Jr., B.S. Research Assistant in Bacteriology. 1 * 

Robert C. Holcombe, A.B., Research Assistant in Pharmacology. 11 

Bernard Kramer, A.B., Research Assistant in Bacteriology. 1 

Anne McNicholas Laster, A.B., Research Assistant in Pediatrics. 10 

Joseph R. Merkel, B.S., Research Assistant in Bacteriology 1 

Carolyn Mae Miller, A.B., Research Assistant in Psychiatry. 1 

Irwin H. Moss, A.B., Research Assistant in Medicine. 16 

Jean D. Nimmo, A.B., Research Assistant in Biological Chemistry. 

John Walker Powell, Ph.D., Research Assistant in Psychiatry. 1 

Jeannette F. Rayner, Research Assistant in Psychiatry. 

Elizabeth R. Steele, A.B., Research Assistant in Anatomy." 

Carolyn M. Stout, M.S., Research Assistant in Physiology. 1 ' 

Effective appointment dates; Fellows. 

11 Oct. 1, 1950. 

lh April 16, 1951. 

Effective appointment dates: Consultants. 

la Oct. 1, 1951. 

Effective appointment dates: Research Assistants. 

ta Feb. 1, 1951. 

lb Jan. 1, 1951. 

lc June 7, 1951 to Apr. 30, 1952. 

ld April 1, 1951. 

" Jan. 15, 1951. 

* June 1, to July 31; Sept. 1 ,to Sept. 15, 1951. 

11 Aug. 31, 1951. 

« Junel, to July 31, 1951. 

11 July 16, 1951. 



22 UNIVERSITY OF MARYLAND 

Barbara Elizabeth Todd, A.B., Research Assistant in Psychiatry. 1 ' 
Albert L. Tucker, A.B., Research Assistant in Pediatrics. 111 
Margaret Lucille Ward, A.B., M.SS., Research Assistant in Pediatrics. 111 
Amy Lee Wells, R.N., Research Assistant in Gynecological Pathology. 1 ™ 
David Willenson, M.S., Research Assistant in Psychology. 16 
Richard A. Young, M.D., Research Assistant in Pediatrics. 115 

EXTRAMURAL ASSISTANT RESIDENTS IN MEDICINE 

John F. Benson, M.D., Assistant Resident in Medicine. 

Robert H. Hahn, M.D., Rotating Assistant Resident in Medicine. 

Howard E. Hall, M.D., Assistant Resident in Medicine. 

John A. Hightower, M.D., Rotating Assistant Resident in Medicine. 

William Roemmich, M.D., Assistant Resident in Medicine. 

Sidney J. Venable, M.D., Assistant Resident in Medicine. 

UNIVERSITY HOSPITAL 

George H. Buck, Director 

James L. Dack, Asst. Director 

Kurt H. Nork, Asst. Director 

EXECUTIVE COMMITTEE OF THE STAFF 

Edward F. Cotter, Chairman 
Francis G. Dickey, Secretary-Treasurer 
J. Edmund Bradley Walter L. Kilby 

Louis H. Douglass F. Edwin Knowles, Jr. 

Charles Redj Edwards Alfred T. Nelson 

Jacob E. Finesinger Maurice C. Pincoffs 

J. Mason Hundley, Jr. Milton S. Sacks 

George H. Yeager 

Elected Members Term Expires 
A. H. FlNKELSTEIN 1951 

Ephraim T. Lisansky 1951 

James G. Arnold, Jr 1952 

Ernest I. Cornbrooks, Jr 1952 

Everett G. Diggs 1953 

William G. Helfrich 1953 

George H. Buck, Director, University Hospital] 



}Ex officio members 
H. Boyd Wylie, Dean, School of Medicine 



Effective appointment dates: Research Assistants. 

le Sept. 1, 1950. 

lh June 15, to Aug. 31, 1951. 

lk Aug. 1, to Dec. 1, 1951. 

11 July 16, 1951. 

to May 1 to Aug. 31, 1951. 

lD Sept. 1, 1951. 



SCHOOL OF MEDICINE 



23 



UNIVERSITY HOSPITAL STAFF 



Physicians . 



Neurologists . 



Pkysician-in-Chief Maurice C. Pincoffs 

Thomas P. Sprunt 
T. Nelson Carey 
Louis A. M. Krause 
William S. Love, Jr. 
Howard M. Bubert 
Milton S. Sacks 
Lewis P. Gundry 
Samuel Morrison 
Thedore E. Woodward 
Frank J. Geraghty 
Edward F. Cotter 
C. Edward Leach 
Ephraim T. Lisansky 
^Samuel T. R. Revell, Jr. 
Irving J. Spear 
Leon Freedom 
William Fearing 
Edward F. Cotter 
George Merrill 

Dermatologist-in-Chief Harry M. Robinson, Sr. 

[Francis A. Ellis 
Harry M. Robinson, Jr. 

Dermatologists \ A. Albert Shapiro 

I Israel Zeligman 
[Eugene S. Bereston 

Psychiatrist-in-Chief Jacob E. Finesinger 

[H. Whitman Newell 

Psychiatrists -JKathryn L. Schultz 

[Ephriam T. Lisansky 

Pediatrician-in-Chief J. Edmund Bradley 

C. Loring Joslin 
Gordon E. Gibbs 
A. H. Finkelstein 
William M. Seabold 

Patkologist-in-Chief Hugh R. Spencer 

f Dexter L. Reimann 
'[John A. Wagner 

Surgeon-in-Chief Charles Redd Edwards 

George H. Yeager 
Otto C. Brantigan 
Charles A. Reifschnehjer 
Harry C. Hull 
Neurological Surgeon-in-Chief Charles Bagley, Jr. 

[Richard G. Coblentz 

Surgeons ' 



Pediatricians . 



Pathologists . 



Surgeons . 



Neurological 



(James G. Arnold, Jr. 



24 



UNIVERSITY OF MARYLAND 



Orthopedic Surgeons . 



Dentists . 



UNIVERSITY HOSPITAL STAFF— Cont'd. 
Laryngologist-in-Chief Edward A. Looper 

Laryngologists ( Thomas R. O'Rourk 

[Frederick T. Kyper 

Proctolologist-in-Chief Monte Edwards 

Proctologist Thurston R. Adams 

Orthopedic Surgeon-in-Chief Allen F. Voshell 

Moses Gellman 
Henry F. Ullrich 
Melton J. Wilder 
James P. Miller 
Urologist-in-Chief W. Houston Toulson 

I LYLE J. MlLLAN 

Urologists | Howard B. Mays 

[John D. Young 

Dental Surgeon-in-Chief Brice M. Dorsey 

Myron S. Aisenberg 
Joseph C. Blddix 
Harold Golton 
Joseph P. Cappuccio 
Edward C. Dobbs 
Grayson W. Gaver 
Hugh T. Hicks 
Conrad L. Inman 
Ernest B. Nuttall 
Kenneth V. Randolph 
Wilbur 0. Ramsey 
Lewis C. Toomey 

Roentgenologist-in-Chief Walter L. Kilby 

„ , . M { Charles N. Davidson 

Roentgenologists L-. T „ 

{ Donald J. Barnett 

[John M. Dennis 

Bronchoscopist-in-Chief Edward A. Looper 

Thomas R. O'Rourk 

Frederick T. Kyper 

John H. Hirschfeld 

Richard J. Cross 6 

Ross C. Brooks 

John M. Rehberger 

Thomas D. Michael 

Otologist-in-Chief Thomas R. O'Rourk 

Anesthesiologist-in-Chief Alfred T. Nelson 

Anesthesiologist Frank J. Brady 

/ Louis H. Douglass 

\D. Frank Kaltretder 

J. Morris Reese 

ISADORE A. SlEGEL 

' Ijohn E. Savage 
Hugh B. McNally 

Ophthalmologist-in-Chief F. Edwin Knowles, Jr. 

Ophthalmologist Paul N. Friedman 



Bronchoscopists . 



Obstetricians-in-Chief . 



Obstetricians . 



Gynecologists . 



SCHOOL OF MEDICINE 25 

UNIVERSITY HOSPITAL STAFF— Cont'd. 

(jOHN C. OZAZEWSKI 

Assistant Ophthalmologists I J. E. Brumback 

[Ruby A. Smith 

Gynecologist-in-Chief J. Mason Hundley, Jr. 

[Leo Brady 
I Beverley C. Compton 
I William K. Diehl 
Everett S. Diggs 
Ernest I. Cornbrooks, Jr. 
John C. Dumler 
Oncologist-in-Chief J. Mason Hundley, Jr. 

UNIVERSITY HOSPITAL RESIDENT AND INTERN STAFF 
July 1, 1951 to June 30, 1952 

Jose A. Alvarez, B.S., M.D., Co-Resident in Neurosurgery, Baltimore City Hospital, 
July 1, 1951 to January 31, 1952; Resident in Neurological Surgery University Hos- 
pital, Feb. 1, 1952 to June 30, 1952. 

Charles Bagley, III, B.S., M.D., Assistant Resident in Surgery 

Claude F. Bailey, A.B., M.D., Assistant Resident in Gynecology 

Thomas G. Barnes, A.B., M.D., Co-Resident in Surgery 

James M. Bisanar, M.D., Assistant Resident in Pediatrics 

Francis J. Borges, B.S., M.D., Assistant Resident in Medicine 

Joseph B. Bronushas, B.S., M.D., Assistant Resident in Medicine 

James S. Browne, M.D., Assistant Resident in Neurosurgery 

Donald B. Campbell, M.D., Assistant Resident in Obstetrics 

Garrett E. Deane, M.D., Resident in Pediatrics 

Victor H. Esch, M.D., Assistant Resident in Surgery 

John E. Evans, B.S., M.D., Assistant Resident in Surgery 

Joseph E. Furman, B.S., M.D., Assistant Resident in Pediatrics 

Joseph B. Ganey, A.B., M.D., Co-Resident in Surgery 

Richard A. Gilbert, M.D., Resident in Gynecology 

Martin K. Gorten, A.B., M.D., Assistant Resident in Pediatrics 

Angelina Guddo, A.B., M.D., Resident in Ophthalmology 

John R. Hankins, B.A., M.D., Assistant Resident in Surgery 

Robert M. Hxdey, Jr., M.D. Assistant Resident in Pediatrics 

John A. Hightower, M.D., Resident in Medicine 

Erwin R. Jennings, A.B., M.D., Assistant Resident in Surgery 

Douglas O. Kern, M.D., Assistant Resident in Gynecology 

August Klel, Jr., M.D., Assistant Resident in Neurosurgery 

Eugene R. McNinch, M.D., Fellow in Roentgenology 

James R. McNinch, Jr., A.B., M.D., Assistant Resident in Surgery 

Arlie R. Mansberger, Jr., M.D., Assistant Resident in Surgery 

Mary E. Matthews, B.S., M.S., M.D., Assistant Resident in Pediatrics 

Thomas D. Michael, M.D., Assistant Resident in Otolaryngology 

John W. Newman, M.D., Assistant Resident in Obstetrics 

S. Malone Parham, A.B., M.D., Resident in Obstetrics 

Sim Penton, M.D., Resident in Thoracic Surgery 

Carol G. Pryor, A.B., M.D., Assistant Resident in Gynecology 

Benson C. Schwartz, M.D., Assistant Resident in Obstetrics, assigned to Gynecology. 



26 



UNIVERSITY OF MARYLAND 



George VV. Smith, B.S., M.D., Co-Resident in Neurosurgery, University Hospital, July 1, 
1951 to January 31, 1952; Resident in Neurological Surgery Mercy Hospital, Feb. 
1, 1952 to June 30, 1952. 

Edward P. Smith, Jr., B.S., M.D., Assistant Resident in Surgery 

Jose G. Valderas, M.D., Assistant Resident in Gynecology, assigned to Obstetrics 

Leslie A. Walker, Jr., M.D., Assistant Resident in Gynecology 

John P. White, III, M.D., Assistant Resident in Surgery 

Richard A. Young, A.B., M.D., Assistant Resident in Pediatrics 

Henry F. Zangara, B.S., M.D., Resident in Roentgenology 1 

ROTATING INTERNS 



John W. Bossard, B.A., M.D. 
George M. Dunn, Jr., M.D. 
Joseph C. Fitzgerald, B.A., M.D. 
Henry E. Langenfelder, B.A., M.D. 
John S. Metcalf, Jr., M.D. 
Robert A. Moore, Jr., A.B., M.D. 
Robert S. Mosser, B.S., M.D. 



Arthur Schmale, M.D. 



Henry D. Perry, Jr., A.B., M.D. 

Henry G. Reeves, Jr., B.S., M.D. 

Eugene B. Rex, M.D. 

Aubrey D. Richardson, B.S., M.D. 

Roger D. Scott, M.D. 

R. Kennedy Skipton, B.S., M.D. 

Charles P. Watson, Jr., A.B., M.D. 

EXTERN 

.... Department of Medicine 



UNIVERSITY HOSPITAL OUTPATIENT DEPARTMENT STAFF 

Kurt H. Nork Director 

Chief of Medical Clinic Maurice C. Pincoffs 

Assistant Chief, Medical Clinic Joseph C. Furnari 

T. Nelson Carey 



Consultants. 



Physicians . 



L. A. M. Krause 
William K. Waller 
Walter Karfgin 
Louis V. Blum 
Kurt Levy 
Alvin Hartz 
Joseph E. Muse, Jr. 
James R. Karns 
Morris Fine 
Jonas Cohen 
John B. DeHoff 
! Robert E. Bauer 
Charles H. Williams 
Stephen Van Lill, III 
Charles E. Shaw 
Joseph G. Bird 
Marvin Goldstein 
Donald Mintzer 
Fred Agee 
Marvin Davis 
Herbert Levicus 
Lauriston Keown 



1 Until October 31, 1951. Fellow beginning November 1, 1951. 



SCHOOL OF MEDICINE 



27 



UNIVERSITY HOSPITAL OUTPATIENT DEPARTMENT— cont'd. 



Assistant Gastro- Enter olo gist . 



Assistant Neurologists. 



Assistant Cardiologists . 



Chief of Gastro-Enterology Clinic Francis G. Dickey 

fz. Vance Hooper 
' \ Albert J. Shochat 

Chief of Neurology Clinic Leon Freedom 

(William L. Fearing 
\ Harry A. Teitelbaum 

Chief of Chest Clinic Meyer W. Jacobson 

Assistant, Diseases of the Lungs Manuel Levin 

Chief of Diabetic Clinic Samuel T. R. Revell, Jr. 

(Charles E. Shaw 

Assistants j Joseph G. Bird 

[ Perry O. Futterman 

Chief of Cardiovascular Clinic C. Edward Leach 

Wilfred H. Townshend 
Rollin C. Hudson 
Sidney Scherlis 
Stephen J. Van Lill, III 
Fred B. Agee, Jr. 
James J. Nolan 

Chief of Allergy Clinic Howard M. Bubert 

Assistant Chiefs of Allergy Clinic { 

[Jerome Sherman 

Assistant Allergists /Edward S. Kallins 

[Raymond M. Lauer 

Allergy Clinic Technician Anna Sutch 

Chief of Endocrinology Clinic Conrad B. Acton 

Director of Dermatology and Syphilis Clinic Harry M. Robinson, Sr. 

Chief of Dermatology and Syphilis Clinic Harry M. Robinson, Jr. 

Francis A. Ellis 
Israel Zeligman 
A. Albert Shapiro 
R. C. V. Robinson 
Eugene S. Bereston 
William R. Bundick 



Dermatologists and Sy philologists . 



Assistant Dermatologists and Syphilologists . 



Benjamin Highstein 
Lucile Caldwell 
V. Harwood Link 
Morris M. Cohen 
Mark B. Hollander 
Lee R. Lerman 



Director of Psychiatric Clinic H. Whitman Newell 



28 



UNIVERSITY OF MARYLAND 



UNIVERSITY HOSPITAL OUTPATIENT DEPARTMENT— Cont'd. 

Kathryn L. Schultz 
Hans W. Loewald 

Ephriam Lisansky 
isadore tuerk 
Rudolph Marburg 
Sam Novey 
G. S. Ingalls 
Leon Ferber 
Gertrude Gross 
Enoch Gallaway, III 
William N. Fitzpatrick 
Marion Mathews 
Marvin Jaffe 
Virginia Suttonfield 



A ssistant Psychiatrists . 



Chief Roentgenologist. 
Roentgenologists 



Director, Pediatric Clinic. 
Chief of Pediatric Clinic . . 



A ssistant Pediatricians . 



Director, Pediatric Cardiac Clinic 

Assistant Director, Pediatric Cardiac Clinic. 

Assistant Pediatrician, Cardiac Clinic 

Director, Pediatric Seizure Clinic . 

Chief of Surgical Clinic 



Assistant Surgeons. 



. Walter L. Kilby 

f John M. Dennis 
.{ Charles N. Davidson 
[Donald J. Barnett 

. A. H. Finkelstein 

. Samuel S. Glick 

Louis V. Blum 
Arnold F. Lavenstein 
Thomas E. Weeks 
J. Carlton Wich 
Howard Goodman 
Melvtn N. Borden 
Lester Caplan 
Ruth B. Baldwin 
Edward Fields 
Latimer Young 
C. R. Gonzales 

Sidney Scherlis 

Gibson J. Wells 

Mary Hayleck 

Ruth B. Baldwin 

Robert C. Sheppard 

Samuel E. Proctor 
William B. Settle 
Karl F. Mech 
James N. Cianos 
Richard M. Garrett 
William D. Lynn 
David R. Will 



Chief of Plastic Surgery Edward A. Kitlowski 



SCHOOL OF MEDICINE 



29 



UNIVERSITY HOSPITAL OUTPATIENT DEPARTMENT— Cont'd. 
Chief of Orthopedic Surgery Clinic Allen Fiske Voshell 

Moses Gellman 
Henry F. Ullrich 
Milton J. Wilder 
James P. Miller 
Robert C. Abrams 
Everett D. Jones 
John J. Tansey 
John L. Wooton 

W. Houston Toulson 



Assistant Orthopedic Surgeons. 



Chief of Urology Clinic . 



Assistant Urologists. 



Chief of Otolaryngology Clinic. 
Otolaryngologists 



Assistant Proctologists . 



John F. Hogan 
Lyle J. Millan 
Morris A. Fine 
Howard B. Mays 
John D. Young 
Martin A. Robbins 

Benjamin S. Rich 

f Samuel L. Fox 
I Albert Stelner 
. { Richard J. Cross 6 
| John M. Rehberger 
(Thomas D. Michael 

Chief of Proctology Clinic Monte Edwards 

(Thurston R. Adams 
Donald B. Hebb 
) William J. Supik 
[Raymond Cunningham 

Chief of Gynecology Clinic J. Mason Hundley, Jr. 

Assistant Chief of Gynecology Clinic Beverley C. Compton 

William K. Diehl 
Everett S. Diggs 
Ernest I. Cornbrooks, Jr. 
W. Allen Deckert 
Helen I. Maginnis 
Charles B. Marek 
Theodore Kardash 
John C. Dumler 

J. Mason Hundley, Jr. 
Beverley C. Compton 
William K. Dlehl 
Ernest I. Cornbrooks, Jr. 
Everett S. Diggs 

Chief of Dental Clinic Brice M. Dorsey 

A ssistant Chief of Dental Clinic Lewis C. Toomey 



Assistant Gynecologists. 



Female Cystoscopists . 



30 



UNIVERSITY OF MARYLAND 



Assistant Obstetricians . 



Assistants in Gynecological Division. 



UNIVERSITY HOSPITAL OUTPATIENT DEPARTMENT-CWU 

{ Jose Medina 

_ . I Marshall I. Kader 

Assistant Dentists ,. _ T 

Algert P. Lazauskas 

[Edmond G. Vanden Bosche 

Chief of Obstetrical Clinic J. Huff Morrison 

Assistant Chief of Obstetrical Clinic Margaret B. Ballard 

J. K. B. E. Seegar 

Charles H. Doeller, Jr. 

George H. Davis 

Theodore Kardash 

Harry McB. Beck 

William A. Dodd 

Irvin P. Klemkowski 

Clarence W. Martin 

Vernon C. Kelly 

Harry Cohen 

Chief of Oncology Clinic, Gynecological Division . J. Mason Hundley, Jr. 

Beverley C. Compton 

William K. Diehl 

Ernest I. Cornbrooks, Jr. 

Everett S. Diggs 

John C. Dumler 

Arthur G. Siwinski 

E. Eugene Covington 

{ J. DUER MOORES 

Edwin H. Stewart, Jr. 

Louis E. Goodman 

Chief of Vascular Clinic George H. Yeager 

Assistant Chief of Vascular Clinic Raymond Cunningham 

Medical Consultant — Vascular Clinic Lewis P. Gundry 

Chief of Ophthalmology Clinic F. Edwin Knowles, Jr. 

Paul N. Friedman 

Ruby A. Smith 

Assistant Ophthalmologists < _ "j; " 

J. E. Brumback, Jr. 

Richard J. Cross 6 

John C. Ozazewski 

Professor of Speech Ray Ehrensberger, Ph.D. 

Associate Professor of Speech, University of 

Maryland at College Park Merle Ansberry, Ph.D. 

OUT-PATIENT REPORT 
JANUARY 1, 1950 TO JANUARY 1, 1951 

Departments New Cases Old Cases Total 

Allergy 190 4,973 5,163 

Arthritis 55 247 302 

Cardiology 195 1, 150 1,345 



A ssistanls in Surgical Division . 



SCHOOL OF MEDICINE 31 

Departments New Case 

Cystoscopy (Gynecological) 94 

Cystoscopy (Genito-Urinary) 77 

Dermatology 5, 401 

Department "S" 374 

Diabetic 99 

Ear, Nose and Throat 1,267 

Endocrine 41 

Eye 1,428 

Gastro-intestinal 197 

Genito-urinary 937 

Gynecology 2,077 

Hematology 17 

Medical 2,609 

Neurology 129 

Neuro-surgery 211 

Obstetrics 2,012 

Occupational Therapy 82 

Oncology 320 

Oral Surgery 312 

Orthopedics 1 , 478 

Pediatrics 2, 349 

Pediatric Cardiology 21 

Pediatric Chest 6 

Pediatric Seizure 77 

Physiotherapy 76 

Plastic Surgery 32 

Proctology 207 

Psychiatry 315 

Surgery 3, 301 

Tuberculosis 248 

Vascular 157 

Total : 26,391 84,781 111,172 



MEDICAL CARE CLINIC 



UNIVERSITY HOSPITAL 

Director Henry W. D. Holljes 

Assistant Director Martha Curtis 



The Medical Care Clinic of the University of Maryland is the result of a study 
by the Medical and Chirurgical Faculty of Maryland in cooperation with the 
State Planning Commission. The present Clinic, located on the third floor of 
the Dispensary Building, is the first of its kind in this country. Public assistance 
clients are referred to the Clinic by the Baltimore City Health Department and 
are scheduled for an initial physical examination by physicians affiliated with the 



Old Cases 


Total 


546 


640 


50 


127 


8,744 


14,145 


2,365 


2,739 


1,910 


2,009 


2,010 


3,277 


280 


321 


3,320 


4,748 


719 


916 


1,914 


2,851 


5,195 


7,272 


535 


552 


6,236 


8,845 


384 


513 


415 


626 


17,082 


19,094 


1,058 


1,140 


1,707 


2,027 


556 


868 


3,210 


4,688 


8,097 


10,446 


213 


234 


416 


422 


236 


313 


484 


560 


30 


62 


339 


546 


1,589 


1,904 


6,926 


10,227 


975 


1,223 


870 


1,027 



32 UNIVERSITY OF MARYLAND 

University of Maryland. A family physician is chosen by the patient from a list 
available at the Clinic. Copies of the individual's medical history and examina- 
tions are sent to the physician selected, who then becomes responsible for the 
medical care of the patient. 

The Medical Care Program is, in this way, an entirely new approach to the 
problem of the indigent patient. For the first time, he becomes the responsibility 
of a private physician. This places the practice of medicine to the indigent on a 
par with the practice of private medicine. 

After the initial examination, the Clinic functions as a diagnostic center to 
serve the needs of the neighborhood practitioner. Consultants working in the 
Medical Care Clinic are available and at present represent Medicine, Surgery, 
Gynecology and Otolaryngology. Others will be added as required. 

The Clinic functions between 8:30 and 4:30 daily. Registrations and referrals 
are conducted in the morning. Clinical examinations and consultations are held 
during the afternoon. Approximately eighty neighborhood physicians have 
agreed to work with the Medical Care Program. Twenty-five members of the 
Out-patient Department and University Hospital Staff will conduct examinations 
in the Clinic. 

The Faculty Committee on Post Graduate Education has also undertaken plans 
to provide instruction to all affiliated physicians. 

4,606 public assistance clients have been assigned to this Clinic. 



MERCY HOSPITAL 
BOARD OF GOVERNORS 

Walter D. Wise, Chairman 

Mother M. Bernadette Henry F. Bongardt 

Sister M. Veronica H. Raymond Peters 

Sister M. Carmel Maurice C. Pincoffs 

Sister M. Ellen Marie Waitman F. Zinn 

Sister M. Frances Louise Thomas K. Galvin 

Sister M. Damian | - , Edward P. Smith 

Sister M. Thomas Elliott H. Hutchins 

Sister M. Brendan Simon Brager 

ADVISORY BOARD OF MERCY HOSPITAL 

Most Reverend Lawrence J. Sheehan August B. Haneke 

Henry C. Evans Samuel H. Hoffberger 

Thomas B. Butler James W. McElroy 

H. C. Byrd Allen W. Morton 

Charles C. Conlon S. Page Nelson 

Clarence E. Elderkin Thomas W. Pangborn 

Richard A. Froehlinger William F. Schmick 
William L. Galvin 



SCHOOL OF MEDICINE 



33 



MERCY HOSPITAL STAFF 



Surgeon-in-Chitf . 



Surgeons 



Neurological Surgeon-in-Chief . 



Neurological Surgeons 



Associate Surgeons 



Assistant Surgeons . 



Thoracic Surgeon-in-Chief . 
Plastic Surgeons 



Ophthalmologist-in-Chief . . 
Associate Ophthalmologist . 



Associate Ophthalmologists and Otologists 



Walter D. Wise 
f Elliott H. Hutchins 
D. J. Pessagno 
F. L. Jennings 
R. W. Locher 
Thomas R. Chambers 
William F. Rienhoff 
Henry F. Bongardt 
Charles Bagley, Jr. 
Richard B. Coblentz 
James D. Arnold, Jr. 
{ Frank J. Otenasek 
| John W. Chambers 
[Raymond K. Thompson 
I. O. Rjdgely 
James W. Nelson 
Howard B. McElwain 
Simon H. Brager 
John A. O'Connor 
Charles W. Maxson 
I. Rddgeway Trimble 
Raymond F. Helfrich 
Julius Goodman 
S. Demarco, Jr. 
T. J. Touhey 
William N. McFaul, Jr. 
Meyer H. Zuravtn 
Howard L. Zupnhc 
Daniel R. Robinson 
Joseph V. Jerardi 
Wm. C. Dunnigan 
Harold H. Burns 
William L. Garlick 
John F. Schaeffer 
F. Ford Loker 
Patrick C. Phelan, Jr. 
Michael L. DeVincentis 
Harold P. \Beehl 
William L. Garlick 

fEDWARD A. KlTLOWSKI 

\ Clarence P. Scarborough 
F. Edwin Knowles, Jr. 
Joseph V. Jeppi 

(M. Raskin 
Joseph I. Kemler 
F. A. Pacienza 



34 UNIVERSITY OF MARYLAND 

MERCY HOSPITAL STAFF— Cont'd. 

„ ... D , . , . . ,, ... (W. Raymond McKenzie 

Consulting Rhinologists and Laryngologists < _ _. ,_ 

6 6 ^66 [George W. Mitchell 

Rhinologist and Laryngologist -in-Chief Waitman F. Zinn 

Fayne A. Kayser 

Benjamin S. Rich 

Associate Rhinolo gists and Laryngologists • Theodore A. Schwartz 

Benjamin H. Isaacs 

Arthur Ward 

Assistant Rhinologist and Laryngologist Joseph V. Jeppi 

Bronchoscopist-in-Chief Waitman F. Zinn 

Associate Bronchoscopist Fayne A. Kayser 

. . . , „ , ... . [Theodore A. Schwartz 

Assistant Bronchoscopists < _ _ _ 

[Robert Z. Berry 

Orthopaedic Surgeon-in-Chief H. L. Rogers 

Associate Orthopaedic Surgeon Henry F. Ullrich 

(I. H. Maseritz 

Assistant Orthopaedic Surgeons \ ~.' ' _ 

| Isaac Gutman 

[Everett D. Jones 

Proctologist-in-Chief SrMON P. Brager 

Proctologist William J. Supic 

Urologist-ni-Ckief Kenneth D. Legge 

Leon K. Fargo 
Francis W. Gillis 
J. S. Haines 
John D. Young, Jr. 

Dermatologist-in-Chief Francis A. Ellis 

(Eugene S. Bereston 
R. C. V. Robinson 
William R. Bundick 

Dentist J. D. Fusco 

Consulting Dentist Conrad L. Inman 

Consulting Physician Maurice C. Pincoffs 

Consultant, Diseases of the Chest H. Vernon Langeluttig 

Physician-in-Chief H. Raymond Peters 

Harvey G. Beck 
Thomas P. Sprunt 
George McLean 
J. Sheldon Eastland 
Louis A. M. Krause 
Thomas C. Wolff 
T. Nelson Carey 
Sol Smith 



Associate Urologists. 



Physicians . 



SCHOOL OF MEDICINE 



35 



MERCY HOSPITAL STAFF— Cont'd. 



Associate Physicians. 



Assistant Physicians. 



Gastro-Enterologist 

Associate Gastro-Enterologist . 

Consulting Pediatrician 

Pediatrician-in-Ckief 

Associate Pediatrician 



Assistant Pediatricians. 



Associate Neurologists and Psychiatrists. 

Anesthesiologist 

Consulting Obstetrician 

Obstetrician-in-Chief 



Obstetricians. 



Hubert C. Knapp 
Bartus T. Baggott 
Wetherbee Fort 
{ Hugh J. Welch 
S. Edwin Muller 
Frederick J. Vollmer 
William H. Kammer 

S. A. TUMMINELLO 

J. Howard Burns 
Earl L. Chambers 

K. W. GOLLEY 

John R. Davis, Jr. 
< J. Emmett Queen 
John C. Osborne 
Arthur Karfgln 
Henry J. Marriott 
James J. Nolan 
Maurice Feldman, Jr. 

Maurice Feldman 
Phild? D. Flynn 
Edgar B. Frledenwald 
Frederick B. Smith 
G. Bowers Mansdorfer 
Jerome Fineman 
0. Walter Spurrier 
Israel P. Meranski 
Edward L. Frey, Jr. 
.' Earl Weeks 
A. M. Bacon, Jr. 6 
Donald D. Cooper 
Joseph M. Cordi 
J. Carlton Wich 

I Harry Goldsmith 
Philip F. Lerner 
George G. Merrill 
| Edward L. Suarez-Murias 
[Frederick S. Wolf 6 
James Russo 
Edward P. Smith 
John J. Erwin 
[Thomas K. Galvin 
J Frank K. Morris 
] Ernest S. Edlow 
[Hugh B. McNally 



6 In Military Service. 



36 



UNIVERSITY OF MARYLAND 



A ssociate Obstetricians . 



MERCY HOSPITAL STAFF— Cont'd. 

f William C. Duffy 



Assistant Obstetricians . 

Gynecologist-in-Chief . . 
Gynecologists 



Associate Gynecologists 



Assistant Gynecologists. 



Pathologist-in-Chief . . 

Pathologist 

Clinical Pathologist . . 
Clinical Hematologist . 
Clinical Biochemist. . . 



Technicians . 



Radiologist 

Technicians (X-ray). 



1 Charles H. Doeller, Jr. 
William A. Dodd 
Harry McB. Beck 
Joseph C. Sheehan 
Robert B. Tunney 
J. Howard Burns 
Harry F. Kane 
William J. Rysanek, Jr. 
Thomas K. Galvin 

(Edward P. Smith 
John J. Erwin 
Frank K. Morris 
[George A. Strauss, Jr. 
I Ernest S. Edlow 
\ Charles H. Doeller, Jr. 

William A. Dodd 

Harry McB. Beck 

William C. Duffy 

Gerald A. Galvin 

Joseph C. Sheehan 

Robert B. Tunney 

Harry F. Kane 

William J. Rysanek, Jr. 

John F. Ullsperger 

Walter C. Merkel 

Hugh R. Spencer 

H. T. COLLENBERG 

H. Raymond Peters 
Charles E. Brambel 
Sister Paula Marie 
Eleanor Behr 
Ellzabeth Johnson 
Carmela E. Minnick 
Constance Chapman 
Rita Berry 
Jeanne Merritt 
Florese Samorodin 
Doris Stang 
Mary Meyer 

^Anne Murdock 
Edward R. Dana 

f Sister M. Kevin 

I Mary Gorman 

{ Henrietta McCaffrey 

| Frances Muth 

[Shirley Akers 



SCHOOL OF MEDICINE 



37 



MERCY HOSPITAL RESIDENT AND INTERN STAFF 

JULY 1, 1951— JUNE 30, 1952 

RESIDENT STAFF 



Karl A. Dillinger, B.S., M.D. 
Clyde D. Thomas, Jr., M.D. 
Margaret L. Sherrard, B.A., M.D. 
Leonard G. Hamberry, A.B., M.D. 
William B. Rever, Jr., M.D. 
Sim Penton, M.D. 
Pomeroy Nichols, Jr., M.D. 

George W. Smith, M.D. 

John A. Ferris, B.S., M.D. 
Arthur R. Fleming, B.S., M.D. 
Howard F. Raskin, B.A., M.D. 
Charles R. Ireland, M.D. 
Frank T. Kasik, Jr., B.S., M.D. 
Frederick J. Heldrich, Jr., B.A., M.D. 



Resident Surgeon 

Associate Resident Surgeon 

Senior Assistant Resident Surgeon 

Junior Assistant Resident Surgeon 

Junior Assistant Resident Surgeon 

Resident in Thoracic Surgery* 

Junior Resident in Neurosurgery {July 1, 1951 

— January 31, 1952) 
Senior Resident in Neurosurgery {February 1, 

1952— June 30, 1952) 
Resident Gynecologist 
Resident Obstetrician 
Resident Physician 
Assistant Resident Physician 
Assistant Resident Physician 
Resident Pediatrician 



INTERNS 

John R. Buell, Jr., M.D. William H. H. Shea, B.S., M.D. 

Raymond L. Clemmons, B.S., M.D. Leslie D. Simmons, B.S., M.D. 

Howard C. Kramer, M.D. Edward N. Sd?ple, M.D. 

Frank R. Perilla, B.S., M.D. John H. Stone, B.S., M.D. 

Jeno Batjmann, M.D.f 

MERCY HOSPITAL DISPENSARY STAFF 



Dispensary Director 

Director of Surgical Clinic . 
Chief of Surgical Clinic . . . 



Assistant Surgeons. 



Sister M. Anita 
Walter D. Wise 
Harold H. Burns 

I. Rddgeway Trimble 
Howard L. Zupnik 
Daniel R. Robinson 
Joseph V. Jerardi 
William C. Dunnigan 
John F. Schaeffer 
\ F. Ford Loker 
Patrick C. Phelan 
Arthur G. Siwinski 
Melvin F. Polek 
Michael L. DeVincentis 
Paul R. Ziegler 
Harold P. Biehl 



* Resident at Mercy, City and University Hospitals. 
f Term expires February 11, 1952. 



38 



UNIVERSITY OF MARYLAND 



MERCY HOSPITAL DISPENSARY STAFF— Cont'd. 

Chief of Plastic Surgery Edward A. Kitlowski 

Assistant in Plastic Surgery Clarence P. Scarborough 

Chief of Urology Clinic Kenneth D. Legge 

Francis W. Glllis 
Assistant Urologists. 



L. K. Fargo 
John S. Haines 
John D. Young, Jr. 

Chief of Orthopaedic Clinic Harry L. Rogers 

Henry F. Ullrich 
Isaac Gutman 

Orthopaedic Surgeons I. H. Maseritz 

Jason H. Gaskel 
Everett D. Jones 

Director of N euro-Surgery Clinic Charles Bagley, Jr. 

(John W. Chambers 
Frank J. Otenasek 
Raymond K. Thompson 

Director of Medical Clinic H. Raymond Peters 

Sol Smith 



Chiefs of Medical Clinic . 



S. Edwin Muller 



Frederick J. Vollmer 
William H. Kammer 
John R. Davis 
J. Emmett Queen 
Charles F. O'Donnell 

Assistant Physicians \ Arthur Karfgin 

John C. Osborne 
Maurice Feldman, Jr. 
James J. Nolan 
Milton C. Linthicum 
Burton Lock 

Chief of Allergy Clinic S. Edwin Muller 

Chief of Cardiovascular Clinic Thomas C. Wolff 

JLeon Ashman 
'\ Henry J. Marriott 

Chief of Metabolism Clinic J. Sheldon Eastland 

Assistant in Metabolism Clinic J. Emmett Queen 

Gastro-Enterologist Maurice Feldman, Sr. 

Associate Gastro-Enterologist Philip D. Flynn 

Director of Pediatric Clinic Fred B. Smith 

Chief of Pediatric Clinic G. Bowers Mansdorfer 



Assistant Cardiologists. 



SCHOOL OF MEDICINE 



39 



MERCY HOSPITAL DISPENSARY STAFF— Cont'd. 

Israel T. Meranski 
O. Walter Spurrier 

Pediatricians { Edward L. Frey, Jr. 

Earl Weeks 
Joseph Cordi 

Director of Neurologic and Psychiatric Clinics Phild? F. Lerner 

Associate Neurologist and Psychiatrist George G. Merrill 

(Edward L. Suarez-Murias 
\ Frank J. Ayd, Jr. 

Director of Dermatology Clinic Francis A. Ellis 

1 Eugene S. Bereston 
R. C. V. Robinson 
William R. Bundick 



Assistant Neurologist and Psychiatrists . 



Oncologist 

Director of Gynecology Clinic . 
Chief of the Gynecology Clinic . 



Assistant Gynecologists . 



James W. Nelson 

Thomas K. Galvin 

. Frank K. Morris 

Edward P. Smith 
J. J. Erwin 
Ernest S. Edlow 
Charles H. Doeller, Jr. 
William A. Dodd 
Harry McB. Beck 
William C. Duffy 
Joseph C. Sheehan 
Robert B. Tunney 
Gerald A. Galvin 
John M. Palese 
John F. Ullsperger 
Harry F. Kane 

John J. Erwin 

Harry F. Kane 
William A. Dodd 
Harry McB. Beck 
Joseph C. Sheehan 
Robert B. Tunney 
William J. Rysanek, Jr. 
Anthony DiPaula 

Esophagoscopist Waitman F. Zinn 

Associate Esophagoscopist Fayne A. Kayser 

(Waitman F. Zinn 

| Theodore A. Schwartz 

Rhinologists and Laryngolo gists - Benjamin H. Isaacs 

Arthur Ward 
Robert Z. Berry 



Chief of Obstetrical Clinic . 



Obstetricians . 



40 UNIVERSITY OF MARYLAND 

MERCY HOSPITAL DISPENSARY STAFF— Cont'd. 

!M. Raskin 
F. A. Pacienza 
Joseph V. Jeppi 

Chief of Proctology Clinic Simon H. Brager 

Assistant Proctologist William T. Supik 

Chief of Dental Clink J. D. Fusco 

Assistant Chief, Dental Clinic Edward R. Stinebert 

Consulting Dentist Conrad L. Inman 

„, . j7 ,. , f Leon Hannan 

Physiotherapists < . _ TT 

[Alice R. Hannan 

(Sister M. Scholastica 6 
Anna Shawbaker 
Marian L. Kinney 

, . f Eva Applegarth 

secretaries < . T 

\ Nancy Arnold 

MEDICAL CARE CLINIC 

Director S. Edwin Muller 

Assistant Director Frances V. Loughney 

The Medical Care Clinic at Mercy Hospital is one of six special clinics established 
and conducted for the Baltimore City Health Department. These clinics were established 
by the Medical and Chirurgical Faculty of Maryland and the State Planning Commission. 
The program takes up an unmet need for the indigent. 

The City Welfare Department certifies recipients of public assistance to the Health 
Department. The Health Department in turn, assigns recipients to one of the medical 
care clinics operated by local hospitals, namely — Johns Hopkins, Sinai, University of 
Maryland, Mercy, Provident and South Baltimore. The clinic assignments are made 
primarily on a geographic basis. 

During the current year the Medical Care Clinic at Mercy Hospital is providing facil- 
ities for three thousand clients. It provides the eligible individual an initial physical 
examination, chest X-ray, bacteriological and other laboratory tests as indicated. Ar- 
rangements are also made by the Clinic to have each client register with a family physi- 
cian of his or her choice selected from those Baltimore physicians who have agreed to par- 
ticipate in the program. The Clinic notifies the physician chosen, and sends to him a 
complete written report of the physical findings. 

The plan gives physicians an opportunity for contacts with the personnel and diagnostic 
facilities of the participating hospitals. At the request of the client's physician, consul- 
tation services of the Staff at Mercy are made available. These services include Medicine, 
Surgery, Gynecology, Urology, Orthopedics, Dermatology, Neurology and other specialties, 
together with clinical laboratory facilities. 

The Mercy Clinic is located on the 4th floor of the College Building. It includes a 
reception area, offices and examining rooms. An active personnel of Doctors, Nurses, 
Medical Technician and Medical Secretary are on duty from 9 A.M. to 5 P.M. 

6 On Leave. 



SCHOOL OF MEDICINE 41 

MERCY HOSPITAL OUT-PATIENT REPORT 
JANUARY 1, 1950 TO JANUARY 1, 1951 

Departments New Cases Old Cases Total 

Allergy 30 164 194 

Bronchoscopic 328 567 895 

Cardiology 85 257 342 

Dental 224 130 354 

Dermatology 338 902 1,240 

Diabetic 49 517 566 

Gastro-intestinal 58 113 171 

Genito-urmary 112 285 397 

Gynecology 438 1 , 195 1,633 

Medical Care 1,929 1,929 

Medicine 617 2,781 3,398 

Neurology 132 362 494 

Neuro-surgery 41 65 106 

Ophthalmology , 405 373 778 

Orthopaedics 256 540 796 

Pediatrics 627 1,733 2,360 

Physiotherapy 99 1,008 1,107 

Plastic Surgery 3 3 

Postnatal 224 2 226 

Prenatal 343 2,879 3,222 

Proctology 71 108 179 

Rhinolaryngology 589 674 1,263 

Surgery 996 2,202 3,198 

Surgical Follow-Up 177 474 651 



Total 8,168 17,334 25,502 

THE BALTIMORE CITY HOSPITALS 

STAFF, 1951-1952 
Parker J. McMillin, Superintendent 
Surgeon-in-Chief Otto C. Brantigan, M.D. 

James C. Owings, M.D. 

I. Ridgeway Trimble, M.D. 
„...,.„ I Amos Koontz, M.D. 

VtstUng Surgeons Thurston R. Adams, M.D. 

Harry C. Bowie, M.D. 
Donald B. Hebb, M.D. 

Visiting Thoracic Surgeon William L. Garlick, M.D. 

Consultant in Traumatic Surgery C. A. Reifschneider, M.D. 

Visiting Hand Surgeon Raymond M. Curtis, M.D. 

[Charles Bagley, M.D. 

Visiting Netiro-Surgeons \ Richard G. Coblentz, M.D. 

(James G. Arnold, M.D. 



42 UNIVERSITY OF MARYLAND 

BALTIMORE CITY HOSPITAL STAFF— Cont'd. 

Assistant Visiting N euro-Surgeon R. K. Thompson, M.D. 

Consultant in Plastic Surgery Edward A. Kitlowski, M.D. 

Visiting Plastic Surgeon Clarence P. Scarborough, M.D. 

Visiting Proctologist Monte Edwards, M.D. 

(W. Houston Toulson, M.D. 
Hugh Jewitt, M.D. 
Howard B. Mays, M.D. 

Assistant Visiting Urologist John D. Young, M.D. 

Consulting Gynecologist J. Mason Hundley, Jr., M.D. 

Visiting Gynecologist Beverly Compton, M.D. 

Visiting Proctologist Monte Edwards, M.D. 

TErNEST I. CORNBROOKS, M.D. 

Assistant Visiting Gynecologists i William K. Diehl, M.D. 

(Everett S. Diggs, M.D. 

it- :• ^ ,1 . j- o /Allen F. Voshell, M.D. 

v isihng Orthopedic Surgeons < , .. T , TT ' r _ 

6 r 6 [Milton J. Wilder, M.D. 

Assistant Visiting Orthopedic Surgeons < F r>T ' MT) 

TT . . . r ... f John Bordley, M.D. 

Vntmg Laryngologtsts j^ T ^^ M D 

. .,,,*■:■ r 7 • i \ John H. Hirschfeld, M.D. 

Assistant Visiting Laryngologtsts < . ,_ T m-r^ 

b J b b [Alfred T. Lieberman, M.D. 

Visiting Ophthalmologist Charles E. Illff, Jr., M.D. 

Visiting Oncologist Arthur G. Siwinski, M.D. 

f Alfred T. Nelson, M.D. 
Visiting Anesthesiologists { Theodore Stacy, M.D. 

[Leonard Abramovitz, M.D. 

Consultant in Peripheral Vascular Diseases George H. Yeager, M.D. 

Chief Pathologist C. Gardner Warner, M.D. 

Visiting Neuropathologist John A. Wagner, M.D. 

Consultant in Psychiatry Esther L. Richards, M.D. 

Chief Radiologist John DeCarlo, Jr., M.D. 

Chief Pediatrician Harold E. Harrison, M.D. 

Assistant Chief Pediatrician Douglas E. Johnstone, M.D. 

.,..,. „ ,. . . f Milton Markowitz, M.D. 

Visitme Pediatricians <_ _, ,,-^ 

[Laurence Finberg, M.D. 

Chief Hospital Physician — Tuberculosis H. Vernon Langeluttig, M.D. 

Assistant Hospital Physician — Tuberculosis Edmund G. Beacham, M.D. 

...... D , . . „ , , . /Alvin S. Hartz, M.D. 

Visiting Physicians — Tuberculosis < T XT _ T - , ^ 

[John H. Hirschfeld, M.D. 

Chief Physician, Acting C. Holmes Boyd, M.D. 

Assistant Chief Physician Howard K. Rathbun, M.D. 



SCHOOL OF MEDICINE 



43 



BALTIMORE CITY HOSPITAL STAFF— Cont'd. 



Visiting Physicians . 



Assistant Visiting Physicians (USPHS). 



Louis A. M. Krause, M.D. 

William G. Speed, III, M.D. 

Crawford N. Kirkpatrick, M.D. 

Earnest Gross, M.D. 

Joseph King, M.D. 

John H. Miller, M.D. 

Donald M. Watkins, M.D. 

Milton Landowne, M.D. 

Rodger K. MacDonald, M.D. 

Morton D. Bogdonoff, M.D. 

Harold M. Silver, M.D. 

Physiologist Nathan W. Shock, PH.D. 

Visiting Neurologist J. W. Magladery, M.D. 

Assistant Visiting Neurologist David B. Clark, M.D. 

Visiting Dermatologist, Raymond C. V. Robinson, M.D. 

Visiting Laboratory Physician Juldjs Waghelstein, M.D. 

Consultant in Hematology Phild? F. Wagley, M.D. 

Consultant in Neurology Frank R. Ford, M.D. 

Chief Dental Surgeon H. Glenn Waring, D.D.S. 

[L. W. Blmestefer, D.D.S. 

Assistant Visiting Dental Surgeons I Michael Varipatis, D.D.S. 

[b. W. Miksinski, D.D.S. 

Orthodontist R. Kent Tongue, D.D.S. 

Exodontist Richard Colman, D.D.S. 

Chief Obstetrician Louis H. Douglass, M.D. 

Visiting Obstetrician J. Morris Reese, M.D. 

D. Frank Kaltrelder, M.D. 



Assistant Visiting Obstetricians. 



John E. Savage, M.D. 
J. William Dorman, M.D. 
W. Newton Long, Jr., M.D. 
George W. Anderson, M.D. 
Louis C. Gareis, M.D, 

THE JAMES LAWRENCE KERNAN HOSPITAL AND 

INDUSTRIAL SCHOOL OF MARYLAND FOR 

CRIPPLED CHILDREN 



STAFF, 1951-1952 

Surgeon-in-Chief and Medical Director Allen Fiske Voshell, A.B., M.D. 

Consultant in Orthopaedic Surgery and Roent- 
genology Albertus Cotton, A.M., M.D. 

Moses Gellman, B.S., M.D. 



Associate Orthopaedic Surgeons. 



Harry F. Ullrich, M.D. 
Winthrop M. Phelps, A.B. 
Milton J. Wilder, M.D. 
David L. Filtzer, M.D. 
James P. Miller, M.D. 



M.D. 



44 UNIVERSITY OF MARYLAND 

KERNAN HOSPITAL STAFF— Cont'd. 

Roentgenologist Charles N. Davidson, M.D. 

Plastic Surgeon Edward A. Kitlowski, A.B., M.D. 

Aurist and Laryngologisi Benjamin S. Rich, A.B., M.D. 

Dentist M. E. Coberth, D.D.S. 

Cardiologist Helen M. Taussig, M.D. 

Pedialrist Melchijah Spragins, M.D. 

Consulting Surgeon Charles Reld Edwards, A.B., M.D. 

Consulting Aurists and Laryngologists Edward A. Looper, M.D., D.Oph. 

Consulting Neurological Surgeon Charles Bagley, Jr., M.A., M.D. 

_, ... ^ , . . M ( Harry M. Robinson, Sr., M.D. 

Consulting Dermatologists | Leqn Ginsburg> m d 

„ ,,. „ . . . /Irving J. Spear, M.D. 

ConsulHng Neurologists | R y ^^ M D 

„ ,,. „,.,., [Benjamin Tappan, A.B., M.D. 

Consulting Pedialrists < T _, _, , . ' 

(J. Edmund Bradley, M.D. 

Consulting Dentist Harry B. McCarthy, D.D.S. 

Consulting Pathologist Hugh R. Spencer, M.D. 

Consulting Roentgenologist Henry J. Walton, M.D. 

n -j . ^ ., . j- o {John J. Tansey, M.D. 

Resident Orthopaedic Surgeons < T x ... , , _. 

r b (John L. Wooten, M.D. 

Superintendent Miss Maud M. Gardner, R.N. 

Dispensary and Social Service Nurse Mrs. Evelyn Byrd Zapf, R.N. 

(Mr. Henry Ewertz 
Mrs. Anna H. Erlanger 
Mrs. Georgiana Wisong 

-, .. 7 „, .. . (Mrs. T. Lynn Buttrick, O.T. 

Occupational Therapist s , r TT ~ ' _ 

t [Miss Virginia Cooper, O.T. 

Instructor in Grammar School Miss Bertha Sendelback 

HISTORY OF THE SCHOOL OF MEDICINE 

The present School of Medicine, with the title University of Maryland School 
of Medicine and College of Physicians and Surgeons, is the result of a consolida- 
tion and merger of the University of Maryland School of Medicine with the 
Baltimore Medical College (1913) and the College of Physicians and Surgeons of 
Baltimore (1915). 

Through the merger with the Baltimore Medical College, an institution of 
thirty-two years' growth, the facilities of the School of Medicine were enlarged in 
faculty, equipment and hospital connection. 

The College of Physicians and Surgeons was incorporated in 1872, and estab- 
lished on Hanover Street in a building afterward known as the MaterniU, the 
first obstetrical hospital in Maryland. In 1878 union was effected with the 
Washington University School of Medicine, in existence since 1827, and the college 
was removed to Calvert and Saratoga Streets. Through the consolidation with 



SCHOOL OF MEDICINE 45 

the College of Physicians and Surgeons, medical control of the teaching beds in 
the Mercy Hospital was obtained. 

The School of Medicine of the University of Maryland is one of the oldest foun- 
dations for medical education in America, ranking fifth in point of age among the 
medical colleges of the United States. It was organized in 1807 and chartered 
in 1808 under the name of the College of Medicine of Maryland, and its first 
class was graduated in 1810. In 1812 the College was empowered by the Legisla- 
ture to annex three other colleges or faculties: Divinity, Law, and Arts and 
Sciences; and the four colleges thus united were "constituted an University by the 
name and under the title of the University of Maryland." 

The original building of the Medical School at the N. E. corner of Lombard and 
Greene Streets was erected in 1812. It is the oldest structure in this country 
from which the degree of doctor of medicine has been granted annually since its 
erection. In this building were founded one of the first medical libraries and one 
of the first medical school libraries in the United States. 

At this Medical School dissection was made a compulsory part of the curriculum, 
and independent chairs for the teaching of gynecology and pediatrics (1867), and 
of ophthalmology and otology (1873), were installed for the first time in America. 

This School of Medicine was one of the first to provide for adequate clinical 
instruction by the erection of its own hospital in 1823. In this hospital intramural 
residency for senior students was established for the first time. 

The School of Medicine has been co-educational since 1918. 

BUILDINGS AND FACILITIES 

The original medical building at the N. E. corner of Lombard and Greene 
Streets houses the office of the Dean, Room 101, the office of the Committee on 
Admissions, Room 102, two lecture halls, the faculty room and office of the assist- 
ant business manager. 

The Administration Building, to the east of the original building, contains the 
Baltimore offices of the Registrar and two lecture halls. 

The laboratory building at 31 South Greene Street is occupied by the depart- 
ments of Pathology, Bacteriology and Biochemistry. 

The Frank C. Bressler Research Laboratory provides the departments of 
Anatomy, Histology and Embryology, Pharmacology, Physiology and Clinical 
Pathology with facilities for teaching and research. It also houses the research 
laboratories of the clinical departments, animal quarters, a laboratory for teaching 
Operative Surgery, a lecture hall and the Bressler Memorial Room. 

This building was erected in 1939-1940 at 29 South Greene Street opposite the 
University Hospital. It was built with funds left to the School of Medicine by 
the late Frank C. Bressler, an alumnus, supplemented by a grant from the Federal 
government. The structure, in the shape of an I, extends east from Greene 
Street, just north of the original building. 

MEDICAL LIBRARY 

The Medical Library of the University of Maryland, founded in 1813 by the 
purchase of the collection of Dr. John Crawford, now numbers 33,000 volumes and 



46 UNIVERSITY OF MARYLAND 

several thousand pamphlets and reprints. Over four hundred of the leading 
medical journals, both foreign and domestic, are received regularly. The library 
is housed in Davidge Hall, in close proximity to classrooms and laboratories, and 
is open daily for the use of members of the faculty, the student body and the 
profession generally. Libraries pertaining to particular phases of medicine are 
maintained by several departments of the medical school. 

The library of the Medical and Chirurgical Faculty of Maryland and the Welch 
Medical Library are open to students of the medical school without charge. 
Other libraries of Baltimore are the Peabody Library and the Enoch Pratt Free 
Library. 

DISPENSARY BUILDING 

The old hospital building has been remodeled and is occupied by the Out-patient 
Department. Thus the students have been provided with a splendidly appointed 
group of clinics for their training in out-patient work. All departments of clinical 
training are represented in this remodeled building and all changes have been 
predicated on the teaching function for which this department is intended. 

The office of the Medical School Physician is located in this building. 

The Department of Art also occupies quarters here. 

UNIVERSITY HOSPITAL 

The University Hospital, which is the property of the University of Maryland, 
is the oldest institution for the care of the sick in the state of Maryland. It was 
opened in September 1823, under the name of the Baltimore Infirmary, and at 
that time consisted of but four wards, one of which was reserved for patients with 
diseases of the eye. 

In 1933-1934 the new University Hospital was erected and patients were 
admitted to this building in November 1934. The new hospital is situated at the 
southwest corner of Redwood and Greene Streets, and is consequently opposite 
the medical school buildings. The students, therefore, are in close proximity 
and little time is lost in passing from the lecture halls and laboratories to the 
clinical facilities of the new building. 

This new building, with its modem planning, makes a particularly attractive 
teaching hospital and is a very valuable addition to the clinical facilities of the 
medical school. 

The new hospital has a capacity of 435 beds and 65 bassinets devoted to general 
medicine, surgery, obstetrics, pediatrics, and the various medical and surgical 
specialties. 

The teaching zone extends from the second to the eighth floor and comprises 
wards for surgery, medicine, obstetrics, pediatrics, and a large clinical lecture hall. 
There are approximately 270 beds available for teaching. 

The space of the whole north wing of the second floor is occupied by the de- 
partment of roentgenology. The east wing houses clinical pathology and special 
laboratories for clinical microscopy, biochemistry, bacteriology, and an especially 
well appointed laboratory for students' training. The south wing provides space 
for electro-cardiographic and basal metabolism departments, with new and very 






SCHOOL OF MEDICINE 47 

attractive air-conditioned or oxygen therapy cubicles. The west wing contains 
the departments of rhinolaryngology and bronchoscopy, industrial surgery, and 
male and female cystoscopy. 

The third and fourth floors each provide two medical and two surgical wards. 
The fifth floor contains two wards for pediatrics, and on the sixth floor there are 
two wards for obstetrics. Each ward occupies the space of one wing of the 
hospital. 

On the seventh floor is the general operating suite, the delivery suite, and the 
central supply station. The eighth floor is essentially a students' floor and affords 
a mezzanine over the operating and delivery suites, and a students' entrance to 
the clinical lecture hall. 

In the basement there is a very well appointed pathological department with a 
large teaching autopsy room and its adjunct service of instruction of students in 
pathological anatomy. 

The hospital receives a large number of accident patients because of its prox- 
imity to the largest manufacturing and shipping districts of the city. 

The obstetrical service provides accommodation for 40 ward patients and 
assures the student abundant obstetrical training. During the year ending De- 
cember 31st 1950, 3217 patients were delivered and discharged. Of these, 2288 
were service cases and available for teaching. Each member of the graduating 
class participated in an average of 15 deliveries in addition to those he attended 
at Baltimore City Hospitals as a junior student. 

The dispensaries associated with the University Hospital and the Mercy Hospi- 
tal are organized upon a uniform plan in order that the teaching may be the same 
in each. Each dispensary has the following departments: medicine, surgery, 
pediatrics, ophthalmology, otology, genito-urinary, gynecology, gastroenterology, 
neurology, orthopaedics, proctology, dermatology, laryngology, rhinology, car- 
diology, tuberculosis, psychiatry, oral surgery and oncology. 

All students in their junior year work each day during one-third of the year 
in the departments of medicine and surgery of the dispensaries. In their senior 
year, all students work one hour each day in the special departments. 

MERCY HOSPITAL 

The Sisters of Mercy first assumed charge of the Hospital at the corner of Cal- 
vert and Saratoga Streets, then owned by the Washington University, in 1874. 
By the merger of 1878 the Hospital came under the control of the College of 
Physicians and Surgeons, but the Sisters continued their work of ministering to the 
patients. 

In a very few years it became apparent that the City Hospital, as it was then 
called, was much too small to accommodate the rapidly growing demands upon it. 
However, it was not until 1888 that the Sisters of Mercy, with the assistance of 
the Faculty of the College of Physicians and Surgeons, were able to lay the corner- 
stone of the present hospital. This building was completed and occupied late in 
1889. Since then the growing demands for more space have compelled the erec- 
tion of additions, until now there are accommodations for 350 patients. 



48 UNIVERSITY OF MARYLAND 

In 1909 the name was changed from The Baltimore City Hospital to Mercy 
Hospital. 

The clinical material in the free wards is under the exclusive control of the 
Faculty of the University of Maryland School of Medicine and College of Physi- 
cians and Surgeons. 

THE BALTIMORE CITY HOSPITALS 

The clinical facilities of the School of Medicine have been largely increased by 
the liberal decision of the Department of Public Welfare to allow the use of the 
wards of these hospitals for medical education. The autopsy material also is 
available for student instruction. 

Members of the junior class make daily visits to these hospitals for clinical 
instruction in medicine, surgery, and the specialties. 

The Baltimore City Hospitals consist of the following separate divisions: 
The General Hospital, 400 beds, 90 bassinets. 
The Hospital for Chronic Cases, 575 beds. 
The Hospital for Tuberculosis, 280 beds. 
Infirmary (Home for Aged) 700 beds. 

THE JAMES LAWRENCE KERNAN HOSPITAL AND INDUSTRIAL SCHOOL OF 
MARYLAND FOR CRIPPLED CHILDREN 

This institution is situated on an estate of 75 acres at Dickeyville. The site 
is within the northwestern city limits and of easy access to the city proper. 

The location is ideal for the treatment of children, in that it affords all the ad- 
vantages of sunshine and country air. 

A hospital unit, complete in every respect, offers all modern facilities for the 
care of any orthopaedic condition in children. 

The hospital is equipped with 80 beds — endowed, and city and state supported. 

The orthopaedic dispensary at the University Hospital is maintained in closest 
affiliation and cares for the cases discharged from the Kernan Hospital. The 
physical therapy department is very well equipped with modern apparatus 
and trained personnel. Occupational therapy has been fully established and 
developed under trained technicians. 

THE BALTIMORE EYE, EAR, AND THROAT HOSPITAL 

This institution was first organized and operated in 1882 as an outgrowth of the 
Baltimore Eye and Ear Dispensary, which closed on June 14, 1882. The name 
then given to the new hospital was The Baltimore Eye and Ear Charity Hospital. 
It was located at the address now known as 625 W. Franklin St. The out-patient 
department was opened on September 18, 1882 and the hospital proper on 
November 1 of the same year. In 1898 a new building afforded 24 free beds 
and 8 private rooms; by 1907 the beds numbered 47; at present there are 60 beds, 
29 of which are free. In 1922 the present hospital building at 1214 Eutaw Place 
was secured and in 1926 the dispensary was opened. In 1928 a clinical laboratory 
was installed. During 1950 the out-patient visits numbered 20,720. 



SCHOOL OF MEDICINE 49 

Through the kindness of the Hospital Board and Staff, our junior students 
have access to the dispensary which they visit in small groups for instruction in 
ophthalmology. 

REQUIREMENTS FOR ADMISSION 

METHOD OF MAKING APPLICATION 

Requests for application forms should be filed not earlier than September '.1 5th 
preceding by one year the desired date of admission. These forms may be secured 
from the Committee on Admissions, School of Medicine, University of Maryland, 
Baltimore 1, Maryland. 

APPLICATION FOR ADMISSION TO THE FIRST YEAR 

Application for admission is made by firing the required form and by having all 
pertinent data sent directly to the Committee on Admissions, in accordance with 
the instructions accompanying the application. 

Consideration will be given applications received after December 1st provided 
the class is not complete. 

APPLICATION FOR ADMISSION TO ADVANCED STANDING 

Students who have attended approved medical schools are eligible to file ap- 
plications for admission to the second- and third-year classes only. These ap- 
plicants must be prepared to meet the current first-year entrance requirements in 
addition to presenting acceptable medical school credentials, and a medical school 
record based on courses which are quantitatively and qualitatively equivalent to 
similar courses in this school. 

Application to advanced standing is made in accordance with the instructions 
accompanying the application form. 

Persons who already hold the degree of Doctor of Medicine will not be admit- 
ted to the Medical School as a candidate for that degree from this university. 

MINIMUM REQUIREMENTS FOR ADMISSION 
The minimum requirements for admission to the School of Medicine are: 

(a) Graduation from an approved secondary school, or the equivalent in 

entrance examinations, and 

(b) Three academic years of acceptable college credit, exclusive of physical edu- 

cation and military sciences, earned in colleges of arts and sciences, 
whose names occur in the current list of "Approved Colleges of Arts and 
Sciences" as compiled by the Council on Medical Education and Hos- 
pitals of the American Medical Association. The quantity and quality 
of this course of study shall be equivalent to that required for recommen- 
dation by the institution where the college courses are being, or have 
been, pursued. 



so 



UNIVERSITY OF MARYLAND 



(c) The following courses and credits in basic required subjects must be 
completed by June of the year the applicant desires to be admitted: 

Semester hours Quarter hours 

General biology or zoology *(6) 8 *(9) 12 

Inorganic chemistry *(6) 8 *(9) 12 

Organic chemistry 6-8 9-12 

General physics *(6) 8 *(9) 12 

English 6 9 

Modern language (German, French, Spanish) . . 6 9 

* Consideration will be given applicants from the New England area where 6 semester 
hours, or 9 quarter hours, is the standard credit for a science course. 



(d) The total semester-hour or quarter-hour credits presented must be equiv- 

alent in quantity and quality to three-fourths of the credit requirement 
for graduation by the recommending institution, exclusive of courses in 
physical education and military sciences. 
Applicants who are unable to complete these requirements by June of the 
year admission is desired, will be considered contingent on places being 
available, provided all basic required courses and credits shall have been 
absolved by June as indicated in (c) above. 

(e) Students will not be admitted who have unabsolved conditions or failures 

in college courses. 



Elective courses should be selected from the following three groups, 
desirable courses are shown in bold face type. 



Highly 



Natural Sciences 
Vertebrate Embryol- 
ogy 
Comparative Vertebrate 

Anatomy 
Quantitative Analysis 
Physical Chemistry 
Mathematics 



Social Sciences 
Economics 
History 

Political Science 
Psychology (a general 

course is desirable) 
Sociology, etc. 



Humanities 
English (an advanced 

course in English 

composition should 

be taken, if possible) 
Scientific German or 

French (A reading 

knowledge of either 

language is desirable, 

although German is 

preferred) 
Philosophy 

Careful attention should be given to the selection of elective courses in the 
natural sciences. It is suggested that the elective list given herewith be used as 
a guide. The remainder of college credits should be accumulated from courses 
designed to promote a broad cultural development. Thirty six hours or the 
equivalent in session hours or courses in the humanities are recommended. 
Students should avoid taking courses in college which are included in the medical 
curriculum, for example histology, human anatomy, bacteriology, physiology, 
neurology and physiological chemistry. 

It is not intended that these suggestions be interpreted as restrictions upon 



SCHOOL OF MEDICINE 51 

the education of students who exhibit an aptitude for the natural sciences or as 
limitations upon the development of students who plan to follow research work in 
the field of medicine. 

In accepting candidates for admission, preference will be given to those appli- 
cants who have acceptable scholastic records in secondary school and college, 
satisfactory scores in the Medical College Admission Test, given in May each 
year, favorable letters of recommendation from their premedical committees, or 
from one instructor in each of the departments of biology, chemistry, and 
physics, and who in other respects give promise of becoming successful students 
and physicians of high standing. 

Those candidates for admission who are permanently accepted will receive 
a certificate of matriculation from the office of the Dean. 

COMBINED COURSE IN ARTS AND SCIENCES AND MEDICINE 
A combined seven years' curriculum leading to the degrees of Bachelor of 
Science and Doctor of Medicine is offered by the University of Maryland. The 
first three years are taken in residence in the College of Arts and Sciences at Col- 
lege Park, and the last four years in the School of Medicine in Baltimore. (See 
University catalogue for details of quantitative and qualitative college course 
requirements.) 

If a candidate for the combined degree completes the work of the first year in 
the School of Medicine with an average of C or better without failures, and if he 
has absolved the quantitative and qualitative college requirements set up by the 
University, he is eligible to recommendation by the Dean of the School of Medicine 
that the degree of Bachelor of Science be conferred. 

Because the general commencement usually takes place before the School of 
Medicine is prepared to release grades of the first-year class, this combined degree 
of Bachelor of Science is conferred at the commencement following the candidate's 
second year of residence in the School of Medicine. 

STATE MEDICAL STUDENT QUALIFYING CERTIFICATES 
Candidates for admission who live in or expect to practice medicine in Pennsyl- 
vania, New Jersey or New York, should apply to their respective state boards of 
education for medical student qualifying certificates (Pennsylvania and New 
Jersey) or approval of applications for medical student qualifying certificates 
(New York). 

Those students who are accepted must file satisfactory State certificates in the 
office of the Committee on Admissions, School of Medicine, before registration. 
No exceptions will be made to this requirement. 

Addresses of the State Certifying Offices 

Director of Credentials Section, Pennsylvania Department of Public In- 
struction, Harrisburg, Pa. 

Chief of the Bureau of Credentials, New Jersey Department of Public In- 
struction, Trenton, N. J. 

Supervisor of Qualifying Certificates, The State Education Department, 
Examinations and Inspections Division, Albany, N. Y. 



52 UNIVERSITY OF MARYLAND 

DEFINITION OF RESIDENCE STATUS OF STUDENTS* 

Students who are minors are considered to be resident students if, at the time 
of their registration, the parents* have been residents of this State for at least 
one year. 

Adult students are considered to be resident students if, at the time of their 
registration, they have been residents of this State for at least one year, provided 
such residence has not been acquired while attending any school or college in 
Maryland. 

The status of the residence of a student is determined at the time of his first 
registration in the university and may not thereafter be changed by him unless, 
in the case of a minor, his parents* move to and become legal residents of this 
state by maintaining such residence for at least one full calendar year. However, 
the right of the student (minor) to change from a non-resident to a resident status 
must be established by him prior to registration for a semester in any academic 
year. 

CURRENT FEES 

Matriculation fee (paid once) $10.00 

Tuition fee (each year) — Residents of Maryland 450.00 

Tuition fee (each year)— Non-Residents 700.00 

Laboratory fee (each year) 25 .00 

Student health service fee (each year) 20.00 

Student activities and service fee (each year). 15 . 00 

fLodging and meals fee 6. 75 

Graduation fee 15 .00 

Re-examination fee (each subject) 5 . 00 

Transcript fee to graduates. First copy gratis, each copy thereafter . . 1 . 00 

RULES FOR PAYMENT OF FEES 

No fees are returnable. 

Make all checks or money orders payable to the "University of Maryland". 

When offering checks or money orders in payment of tuition and other fees, 
students are requested to have them drawn in the exact amount of such fees. 
Personal checks whose face value is in excess of the fees due will be accepted for 
collection only. 

Acceptance. — Payment of the matriculation fee of $10.00 and of a deposit on 
tuition of $50.00 is required of accepted applicants before the expiration date 
specified in the offer of acceptance. This $60.00 deposit is not returnable and 

* The term "parents" includes persons who have been legally constituted the guardians 
of or stand in loco parentis to such minor students. 

t Junior Students will be billed for this fee, covering lodging and meals while on obstet- 
rical service at Baltimore City Hospitals. Section B. on Schedule 2 will be billed for the 
first semester; Section A on Schedule 2 for the second semester. This fee must be paid 
by all junior students whether or not they serve during the previous summer or the 
academic year. 



SCHOOL OF MEDICINE 53 

will be forfeited if the applicant fails to register, or it will be applied to the appli- 
cant's first semester's charges on registration. 

Registration. — All students, after proper certification, are required to register 
at the business office, Gray Laboratory. (See calendar page 5 of this bulletin 
for dates for the payments of fees, and the note regarding late registration fee.) 

One-half of the tuition fee, the laboratory fee, the student health fee, the mainte- 
nance and service fee and the student activities fee are payable on the date specified 
for registration for the first semester. 

The remainder of the tuition fee shall be paid on the date designated for the 
payment of fees for the second semester. Fourth year students shall pay the 
graduation fee, in addition, at this time. 

PENALTY FOR NON-PAYMENT OF FEES 

If semester fees are not paid in full on the specified registration dates, a penalty 
of $5.00 will be added. 

If a satisfactory settlement, or an agreement for settlement, is not made with 
the business office within ten days after a payment is due, the student automatically 
is debarred from attendance on classes and will forfeit the other privileges of the 
School of Medicine. 

REEXAMINATION FEE 

A student who is eligible to reexaminations must pay the business office $5.00 for 
each subject in which he is to be examined, and he must present the receipt to the 
faculty member giving the examination before he will be permitted to take the 
examination. 

STUDENT ACTIVITIES AND SERVICE FEE 

This fee pays for the use of clothing lockers, provides library privileges, main- 
tains student loan collections, a student lounge and cafeteria. It supports a rec- 
reational program for students of all classes, provides photographs for all school 
purposes, including state boards. It supports the activities of the Student 
Council. 

STUDENT HEALTH SERVICE 

James R. Karns, M.D Director, Student Health Service. 

The Medical School has made provision for the systematic care of students ac- 
cording to the following plan: 

1. Preliminary Examination — All new students will be examined during the 
first week of the semester. Notice of the date, time, and place of the examination 
will be announced to the classes and on the bulletin board. The passing of this 
physical examination is necessary before final acceptance of any student. 

2. Medical Attention — Students in need of medical attention will be seen by 
the school physician, Dr. James R. Karns, in his office at the medical school, at 
9 A.M. daily, except Saturday and Sunday. In case of necessity, students will be 
seen at their homes. 



54 UNIVERSITY OF MARYLAND 

3. Hospitalization — If it becomes necessary for any student to enter the hospital 
during the school year, the school has arranged for the payment of part or all of his 
hospital expenses, depending on the length of his stay and special expenses incur- 
red. This applies only to students admitted through the school physician's office. 

4. Physical Defects — Prospective students are advised to have any known 
physical defects corrected before entering school in order to prevent loss of time 
which later correction might incur. 

5. Eye Examination — Each new matriculant is required to undergo an eye 
examination at the hands of an oculist (Doctor of Medicine) within the three 
months immediately preceding his entrance to the School of Medicine. Long 
study hours bring out unsuspected eye defects which cause loss of time and ineffi- 
ciency in study if not corrected before school work is under way. 

6. Limitations — It is not the function of this service to treat chronic conditions 
contracted by students before admission, nor to extend treatment to acute condi- 
tions arising in the period between academic years, unless the school physician 
recommends this service. 

GENERAL RULES 

The right is reserved to make changes in the curriculum, the requirements for 
graduation, the fees and in any of the regulations whenever the university 
authorities deem it expedient. 

GRADING SYSTEM 

Official grades are designated by these symbols: 



mbol 


Scholarship 


Numerical Equivalent 


A 


Superior 


93-100 


B 


Good 


87- 92 


C 


Fair 


80- 86 


D 


Passing 


75- 79 


F 


Failure 


Below 75 


I 


Incomplete 


— 


WF 


Withdrew, failing 


— 



The class standing of seniors only will be released. This standing will appear 
on senior grade reports sent out from the Registrar's office after graduation. 

ADVANCEMENT AND GRADUATION 

1. No medical student will be permitted to begin work for credit in any semester 
of any year who reports for classes later than one week after classes begin, except 
by permission of the Dean. 

2. No student will be permitted to advance with unabsolved failures 

3. An average of C or better without failures in the year most recently com- 
pleted is required for advancement to junior and senior standing and for grad- 
uation. 

4. A student who in any one year has one failure together with grades of D 
in all other subjects, will be dropped from the rolls. 



SCHOOL OF MEDICINE 55 

5. A student who has failures in two completed major subjects will be dropped 
from the rolls. 

6. All students are required to attend 85% of scheduled classes and (excluding 
seniors) take spring examinations unless excused by the Dean. 

7. Should a student be required to repeat any year in any course, he must pay 
regular fees. 

8. A student failing his final examinations for graduation at the end of the fourth 
year will be required to repeat the entire course of the fourth year and take exam- 
inations in such other branches as may be required, provided he is permitted to 
enter the school as a candidate for graduation. 

9. The general fitness of a candidate for graduation as well as the results of his 
examinations will be taken into consideration by the faculty. 

EQUIPMENT 

10. At the beginning of the first year, all freshmen must provide themselves 
with microscopes of a satisfactory type equipped with a mechanical stage and a 
substage lamp. Also, each freshman must possess a complete set of dissecting 
instruments. 

A standard microscope of either Bausch & Lomb, Leitz, Spencer, Zeiss or any 
other make, fitted with the following attachments, will meet the requirements. 

Students are cautioned that odd-lot instruments may be valueless and difficult 
to repair. 

16 mm., lOx, 0.25 N.A. — 4.9 mm. working distance. 

4 mm., 43x, 0.65 N.A. — 0.6 mm. working distance. 

1.8 mm., 97x, oil immersion, 1.25 N.A.— 0.13 mm. working distance. 

Oculars: lOx and 5x. Huygenian eyepieces. 

Triple nose pieces with 16 mm., 4 mm., and 1.9 mm. 125 N.A. oil immersion lens. 

Wide aperture stage with quick screw condenser and built on, but detachable, 
ungraduated mechanical stage. Substage condenser, variable focusing type 1.25 
N.A. with iris diaphragm. A rack and pinion focusing device is preferred. Mir- 
ror plane on one side, concave on the other. A carrying case is recommended. 

Students are cautioned with respect to the purchase of used microscopes since 
some older instruments were equipped with a 4 mm. (high dry) objective whose 
N.A. is marked as 0.85 N.A. This objective has such a short working distance 
(0.3 mm.) that it is difficult or impossible to focus through thick cover glasses or 
the standard haemocytometer cover glass without breakage. All used microscopes 
are subject to inspection and approval by the Department of Microscopic Anatomy, 
second floor Bressler Research Laboratory, 29 S. Greene Street. See Dr. Lutz. This 
inspection is not made during August. 

1 1 . Students in the second year class are required to provide stethoscopes. 

12. Third- and fourth-year students are required to provide themselves with 
haemocytometers, sphygmomanometers, opthalmoscopes and otoscopes. 

STATE QUALIFYING CERTIFICATES 

13. Candidates for admission who live in or expect to practice medicine in 
Pennsylvania, New Jersey or New York must file State qualifying certificates in 



56 UNIVERSITY OF MARYLAND 

the office of the Committee on Admissions, School of Medicine, before registration. 
No exception will be made to this rule. 

EYE EXAMINATION BEFORE ADMISSION 

14. Each new matriculant in each class is required to present to the Committee 
on Admissions a certificate from an oculist, (a graduate in medicine) that the 
matriculate's eyes have been examined and are in condition, with or without 
glasses as the case may be, to endure the strain of close and intensive reading. 

It is required that this examination be completed within three months prior to 
registration and that the certificate be mailed to the Committee on Admissions 
not later than one month before registration. 

AWARDING OF COMBINED DEGREES 

15. Students entering the School of Medicine on a three-year requirement basis 
from colleges which usually grant a degree on the successful completion of the first 
year of medicine, are restricted by the following regulations: 

a — The candidate must present a certificate from his college or university that 
he has absolved the quantitative and qualitative premedical requirements 
for this degree. 

b — The candidate must acquire an average of C or better without failures for 
the work of his first year in the School of Medicine. 

c — The Dean of the School of Medicine reserves the right to withhold his 
recommendation that a bachelor's degree be conferred at a commencement 
which occurs before the official release of first-year medical grades. 

COST OF TRANSCRIPTS 

16. Graduates will receive the first transcript of record without charge. Subse- 
quent copies will cost one dollar each. Requests for transcripts must be filed 
with the Registrar's Office, University of Maryland, Lombard and Greene 
Streets, Baltimore-1, Maryland. 

HOUSING 

There are no housing or living accommodations on the campus of the medical 
school. 

PARKING 

Because of lack of space on the university parking lots no parking facilities 
are provided thereon for students. 

LIBRARY REGULATIONS 

Loan Regulations 

Loan periods have been worked out according to demand for and protection of 
different types of material. 

Two-Week Loans: All books except those on reserve. 

One-Week Loans: All journals except the latest number (which does not 

circulate), and those on reserve. 






SCHOOL OF MEDICINE 57 

Overnight Loans: Books and journals on reserve. 
(4 p.m.-12 :30 a.m.) 

Special Rules for Books on Reserve: 

Students whose names appear on the check-list for the Mercy Hospital section 
will be granted the necessary hours to return reserve books. 

Overnight books may be reserved in advance only within the week in which they 
will be used. Books may be reserved on Saturday for the following Monday. 

Overnight books may not be reserved two successive nights by the same person. 

Advance reserves will be held until one hour before closing. 

Fines 

Fines are imposed not to acquire money, but to assure equal access to books 
Two-Week Loans: 5 1 per day. 
One-Week Loans: 5£ per day. 

Overnight Loans: 15 £ for first hour; 5£ for each additional hour or fraction 
thereof. 

Lost Books: List price of the book. (Lost books should be reported at once). 
All books must be returned, lost books replaced or paid for, and fines paid before 
a student can finish the year in good standing. 

In fairness to all concerned, these rules must be enforced without exception. 

CERTIFICATION FOR STATE BOARD AND NATIONAL BOARD 
EXAMINATIONS 

No student will be certified to State Board or National Board examiners who 
has unabsolved failures in subjects taken during the academic period covered 
by these examinations. 

WITHDRAWALS AND REFUNDS 

Formal Withdrawal Procedures 

Students over 21 years of age desiring to leave the School of Medicine at any 
time during the academic year are required to file with the Dean a written applica- 
tion for withdrawal. In addition, the student must secure an "honorable dismissal 
release" form from the Dean's secretary, and return this to the Dean's office 
appropriately signed by representatives of the departments listed thereon, together 
with his "matriculation certificate." 

If these procedures are not completed, the student will not be entitled to honor- 
able dismissal nor to refund of fees. 

Students under 21 years of age, must supplement the procedures previously 
described with the written consent of their parents or guardians. 

Academic Standing On Withdrawal 

Students who voluntarily withdraw during an academic semester will be given 
no credit. 

Students are not permitted to resort to withdrawal in order to preclude current 
or impending failures. Their standing on withdrawal will be recorded in the 
registrar's office. 



58 UNIVERSITY OF MARYLAND 

Students who withdraw from the School of Medicine, must apply to the Com- 
mittee on Admissions for readmission, unless other arrangements have been con- 
summated with the Dean's written consent. 

Refunds on Withdrawal 

Students who are eligible to honorable dismissal will receive a refund of current 
charges, after the matriculation fee has been deducted, according to the following 
schedule: 

Period elapsed after instruction begins. Percentage refundable 

Two weeks or less 80% 

Between two and three weeks 60% 

Between three and four weeks 40% 

Between four and five weeks 20% 

After five weeks 

PRIZES 

THE FACULTY PRIZE 

The Faculty will award the Faculty Gold Medal and Certificate and five Certifi- 
cates of Honor to six of the first ten highest ranking candidates for graduation 
who, during the four academic years, have exhibited outstanding qualifications 
for the practice of medicine. 

THE DR. A. BRADLEY GAITHER MEMORIAL PRIZE 
A prize of $25.00 is given each year by Mrs. A. Bradley Gaither as a memorial 
to the late Dr. A. Bradley Gaither, to the student in the senior class doing the best 
work in genito-urinary surgery. 

THE WILLIAM D. WOLFE MEMORIAL PRIZE 

(Value $100.00 each) 
A certificate of proficiency and a prize of $100.00 will be awarded each year 
until the fund is dissipated, to the graduate selected by the Advisory Board of the 
Faculty showing greatest proficiency in Dermatology. 

THE DR. LEONARD M. HUMMEL MEMORIAL AWARD 

A gold medal and certificate of proficiency will be awarded annually, as a 
memorial to the late Dr. Leonard M. Hummel, to the graduate selected by the 
Advisory Board of the Faculty who has manifested outstanding qualifications in 
Internal Medicine. 

SCHOLARSHIPS 

All scholarships are assigned for one academic year, unless specifically rea warded 
on consideration of an application. 

Official application forms are obtainable at the Dean's office, where they should 
be filed four months before the ensuing academic year. 

THE DR. SAMUEL LEON FRANK SCHOLARSHIP 
(Value $100.00) 
This scholarship was established by Mrs. Bertha Rayner Frank as a memorial 
to the late Dr. Samuel Leon Frank, an alumnus of this university. 



SCHOOL OF MEDICINE 59 

It is awarded by the Trustees of the Endowment Fund of the University each 
year upon nomination by the Advisory Board of the Faculty "to a medical stu- 
dent of the University of Maryland, who in the judgment of said Council, is of 
good character and in need of pecuniary assistance to continue his medical 
course." 

This scholarship is awarded to a second, third or fourth year student who has 
successfully completed one year's work in this school. No student may hold 
this scholarship for more than two years. 

THE CHARLES M. HITCHCOCK SCHOLARSHIPS 
(Value $100.00 each) 
Two scholarships were established from a bequest to the School of Medicine 
by the late Charles M. Hitchcock, M.D., an alumnus of the university. 

These scholarships are awarded annually by the Trustees of the Endowment 
Fund of the University, upon nomination by the Advisory Board of the Faculty, 
to students who have meritoriously completed the work of at least the first year 
of the course in medicine, and who present to the Board satisfactory evidence of 
a good moral character and of inability to continue the course without pecuniary 
assistance. 

THE RANDOLPH WINSLOW SCHOLARSHIP 
(Value $100.00) 

This scholarship was established by the late Randolph Winslow, M.D., LL.D. 

It is awarded annually by the Trustees of the Endowment Fund of the Univer- 
sity, upon nomination by the Advisory Board of the Faculty, to a "needy student 
of the Senior, Junior, or Sophomore Class of the Medical School." 

"He must have maintained an average grade of 85% in all his work up to the 
time of awarding the scholarship." 

"He must be a person of good character and must satisfy the Faculty Board 
that he is worthy of and in need of assistance." 

THE DR. LEO KARLINSKY MEMORIAL SCHOLARSHIP 
(Value $125.00) 

This scholarship was established by Mrs. Ray Mintz Karlinsky as a memorial 
to her husband, the late Dr. Leo Karlinsky, an alumnus of the university. 

It is awarded annually by the Trustees of the Endowment Fund of the Univer- 
sity, upon the nomination of the Advisory Board of the Faculty, to "a needy stu- 
dent of the Senior, Junior or Sophomore Class of the Medical School." 

He must have maintained in all his work up to the time of awarding the scholar- 
ship a satisfactory grade of scholarship. 

He must be a person of good character and must satisfy the Faculty Board 
that he is worthy of and in need of assistance. 

THE UNIVERSITY SCHOLARSHIP 
A scholarship which entitles the holder to exemption from payment of tuition 
fee for the year, is awarded annually by the Advisory Board of the Faculty to a 
student of the senior class in need of assistance who presents to the Board satis- 
factory evidence of good character and scholarship. 



60 UNIVERSITY OF MARYLAND 

THE FREDERICA GEHRMANN SCHOLARSHIP 

(Value $200.00) 

(Not open to holders of Warfield and Cohen Scholarships) 
This scholarship was established by the bequest of the late Mrs. Frederica 
Gehrmann and is awarded to a third-year student who at the end of the second 
year has passed the best practical examinations in physiology, pharmacology, 
pathology, bacteriology, immunology, serology, surgical anatomy and neuro- 
anatomy. 

THE CLARENCE AND GENEVRA WARFIELD SCHOLARSHIPS 

(Value $300.00 each) 

There are five scholarships established by the regents from the income of the 
fund bequeathed by the will of Dr. Clarence Warfield. 

Terms and Conditions: These scholarships are available to students of any of 
the classes of the course in medicine. Preference is given to students from the 
counties of the state of Maryland which the Advisory Board of the Faculty may 
from time to time determine to be most in need of medical practitioners. 

Any student receiving one of these scholarships must agree, after graduation 
and a year's internship, to undertake the practice of medicine, for a term of two 
years, in the county to which the student is accredited, or in a county selected by 
the Board. In the event that a student is not able to comply with the condition 
requiring him to practice in the county to which he is accredited by the Board, 
the money advanced by the regents shall be refunded by the student. 

THE ISRAEL AND CECELIA E. COHEN SCHOLARSHIP 

(Value $150.00) 

This scholarship was established by the late Eleanor S. Cohen in memory of 
her parents, Israel and Cecelia E. Cohen. Terms and conditions: This scholarship 
will be available to students of any one of the classes of the course in medicine; 
preference is given to students of the counties in the state of Maryland which the 
Advisory Board of the Faculty may from time to time determine to be most in 
need of medical practitioners. Any student receiving one of these scholarships 
must, after graduation and a year's internship, agree to undertake the practice of 
medicine for a term of two years in the county to which the student is accredited, 
or in a county selected by the council. In the event that a student is not able to 
comply with the condition requiring him to practice in the county to which he is 
accredited by the Board, the money advanced by the regents shall be refunded. 

THE DR. HORACE BRUCE HETRICK SCHOLARSHIP 

(Value $125.00) 

This scholarship was established by Dr. Horace Bruce Hetrick as a memorial 
to his sons, Bruce Hayward Hetrick and Augustus Christian Hetrick. It is to 

be awarded by the Advisory Board of the Faculty to a student of the senior class. 



SCHOOL OF MEDICINE 61 

THE HENRY ROLANDO SCHOLARSHIP 
(Value approximately $250.00) 

The Henry Rolando Scholarship was established by the Board of Regents of 
the University of Maryland from a bequest to the Board by the late Anne H. 
Rolando for the use of the Faculty of Medicine. 

This scholarship will be awarded each academic year on the recommendation 
of the Advisory Board of the Faculty to a "poor and deserving student." 

THE READ SCHOLARSHIPS 

The sum of $500.00 is now available to cover two (2) scholarships in the 
amount of $250.00 each for a given academic year. Beginning in 1945, these 
scholarships were made possible by a donation from the Read Drug and Chemical 
Company of Baltimore, Maryland. Two students are to be selected by the Dean 
of the School of Medicine in collaboration with the Scholarship and Loan Commit- 
tees of the Medical School with the provision that the students selected shall be 
worthy, deserving students, residents of the State of Maryland. 

LOAN FUNDS 

W. K. KELLOGG FUND 

This loan fund was established in the academic year 1942 with money granted 
by the W. K. Kellogg Foundation. The interest paid on the loans, together with 
the principal of the fund as repaid, will be used to found a rotating loan fund. 
Loans will be made on the basis of need, character and scholastic attainment. 

FACULTY OF MEDICINE LOAN FUND 

A Faculty of Medicine Loan Fund was established with money derived from 
the bequest of Dr. William R. Sanderson, Class 1882, and the gift of Dr. Albert 
Stein, Class 1907. Loans will be made on the basis of need, character, and 
scholastic ability. 

THE JAY W. EATON LOAN FUND 

This fund was established by the local chapter of the Nu Sigma Nu Fraternity 
in memory of Jay W. Eaton of the class of 1946. 

Beginning in 1946 an interest-free loan of $100.00 will be made to some worthy 
member of the senior class, on recommendation of the Scholarship Committee of 
the School of Medicine. This loan is to be credited to the tuition fee of the ap- 
pointed student and is to be repaid by the student within four years following his 
graduation. 

THE SENIOR CLASS LOAN FUND 

The senior class of 1945 originated this fund which will accumulate by subscrip- 
tion from among members of each senior class. 

The conditions of the agreement provide that the dean of the School of Medicine 
award a loan of $100.00 to a needy member of the senior class on the recommenda- 
tion of a self-perpetuating committee of two members of the faculty. 

Loans from this fund are to be credited to the tuition fee of the appointed 
student and are to be repaid within five years from the date of graduation. 



62 UNIVERSITY OF MARYLAND 

THE STUDENT AID FUND FOR SENIORS 

This fund was originated by the class of 1950 and is sponsored by the senior 
class of each succeeding year. The purpose of the fund is to provide financial 
aid for any deserving member of the senior class. All members of the senior 
class are eligible to apply for a loan. Applications may be filed at the office of the 
dean. 

The conditions of the agreement provide that the Scholarship and Loan Com- 
mittee award loans to members of the senior class on recommendation of a self- 
perpetuating committee of two members of the faculty who may call on the 
president of the senior class for assistance, if desired. 

Loans from this fund are made on a non-interest bearing basis and are payable 
within five years. A signed note is required. No co-signers are necessary. 

ORGANIZATION OF THE CURRICULUM 

The curriculum is organized under fifteen departments. 

1. Anaesthesiology. 

2. Anatomy (including Histology, Embryology, and Neuro-anatomy) . 

3. Bacteriology and Immunology. 

4. Biological Chemistry. 

5. Gynecology. 

6. Medicine (including Medical Specialties). 

7. Obstetrics. 

8. Ophthalmology. 

9. Pathology. 
10. Pediatrics. 

15. Pharmacology and Materia Medica. 

16. Physiology. 

13. Psychiatry. 

14. Roentgenology. 

15. Surgery (including Surgical Specialties). 

The instruction is given in four academic years of graded work. 

Several courses of study extend through two years or more, but in no case are 
the students of different years thrown together in the same course of teaching. 

The first and second years are devoted largely to the study of the structures, 
functions and chemistry of the normal body. Laboratory work occupies most of 
the student's time during these two years. 

Some introductory instruction in medicine and surgery is given in the second 
year. The third and fourth years are almost entirely clinical. 

A special feature of instruction in the school is the attempt to bring together 
teacher and student in close personal relationship. In many courses of instruc- 
tion the classes are divided into small groups and a large number of instructors 
insures attention to the requirements of each student. 

In most courses the final examination as the sole test of proficiency has dis- 
appeared and the student's final grade is determined largely by partial examina- 
tions, recitations and assigned work carried on throughout the course. 



SCHOOL OF MEDICINE 63 

ANESTHESIOLOGY 

Alfred T. Nelson Professor of Anaesthesiology 

and Head of the Department 

Wedon Johnson Associate Professor of Anesthesiology 

Isidore William Towlen Assistant Professor of Anesthesiology 

Frank J. Brady Associate in Anaesthesiology 

James Russo Assistant in Anaesthesiology 

THIRD YEAR 

Lectures are given on the general physiology and pharmacology of anesthesia, 
with consideration of the special physiology and pharmacology of each anaesthetic 
agent. The methods of induction and administration of anaesthesia are discussed. 
The factors influencing the selection of the anaesthetic are emphasized, and the 
preparation and care of the anaesthetized patient are carefully explained. 

These lectures are correlated with practical demonstrations, supplemented by 
lantern slides and motion pictures, at the University Hospital. 

FOURTH YEAR 

Each senior student is required to spend six hours per week for four weeks 
observing and administering anaesthetics in the operating room. 

Third year 10 hours 

Fourth year 24 hours 

Total 34 hours 

ANATOMY 

Eduard Uhlenhuth Professor of Anatomy and Head of the Department 

Frank H. J. Figge Professor of Anatomy 

Otto C. Brantigan Professor of Surgical Anatomy 

0. G. Harne Associate Professor of Anatomy 

Vernon E. Krahl Associate Professor of Anatomy 

W. Wallace Walker Associate Professor of Surgical Anatomy 

John F. Lutz Assistant Professor of Anatomy 

William B. Settle Assistant Professor of Surgical Anatomy 

Karl F. Mech Assistant Professor of Anatomy 

Herbert E. Reifschnelder Associate in Surgical Anatomy 

Harry C. Bowie Associate in Surgical Anatomy 

Ross Z. Pierpont Associate in Surgical Anatomy 

H. Patterson Mack Associate in Anatomy 

Patrick C. Phelan, Jr Associate in Anatomy 

V. V. Brunst Research Associate in Anatomy 

Robert E. McCafferty Instructor in Anatomy 

Gladys E. Wadsworth Instructor in Anatomy 

George W. Smith Instructor in Anatomy 

Richard M. Garrett Assistant in Surgical Anatomy 

Geraldine F. Wolfe U. S. P. H. Fellow 

DeWitt T. Hunter John F. B. Weaver Fellow in Anatomy 

A. Gibson Packard John F. B. Weaver Fellow in Anatomy 

William E. Loechel U.S.P.H. Fellow in Medical Art 



64 UNIVERSITY OF MARYLAND 

Gross Anatomy. First Year. First semester. The gross structure of the 
human body, studied by dissection of the human cadaver. The entire human 
body is dissected. Approximately 370 hours; of these 80 hours are devoted to 
lectures and conferences, the rest to laboratory work and demonstrations. Drs. 
Uhlenhuth, Krahl, Mech, McCafferty, Phelan and Miss Wadsworth. 

First Year. First Semester. Peripheral Nervous System. A lecture course 
of approximately 32 hours, in two-hour periods each Saturday morning. Dr. 
Uhlenhuth. 

Histology and Embryology First Year. First Semester. The Microscopic 
Structure of the Organs, Tissues and Cells of the Human Body. 

This course will present an integrated study of the histology and embryology 
of the human body, but most of the time is devoted to the study of histology. 

An attempt will be made to correlate this with gross anatomy as well as other 
subjects in the medical curriculum. Special emphasis will be placed on the dy- 
namic and functional aspects of the subject. 150 hours. Dr. Figge, Prof. Harne, 
Drs. Lutz, Mack, Brunst and Miss Wolfe. 

Neuroanatomy. First Year. Second Semester. The Central Nervous Sys- 
tem. The study of the detailed anatomy of the central nervous system will 
be coordinated with the structure and function of the entire nervous system. This 
study will require the dissection of a human brain and the examination of stained 
microscopic sections of various levels of the brain stem. 100 hours. Dr. Figge, 
Prof. Harne, Drs. Lutz, Mack, Smith and Miss Wolfe. 

Surgical Anatomy. Second Year. Second Semester. Topographic and 
Surgical Anatomy. The course is designed to bridge the gap between abstract 
anatomy and clinical anatomy as applied to the study and practice of medicine 
and surgery. Students are required to dissect and demonstrate all points, out- 
lines and regions of the cadaver. Underlying regions are dissected to bring out- 
lines and relations of structures. Dr. Brantigan and staff. 

Total hours: 96 

Graduate and Postgraduate Courses. Consult the general catalog of the 
University of Maryland for descriptions of these courses. 

ART AS APPLIED TO MEDICINE 

Carl Dame Clarke Associate Professor of Art as Applied to Medicine 

Thomas M. Stevenson, Jr Assistant in Art as Applied to Medicine 

Jane L. Bleakley Assistant in Art as Applied to Medicine 

Raymond J. Clayton, Jr Assistant in Art as Applied to Medicine 

Shirley K. Fitzgerald Assistant in Art as Applied to Medicine 

Jenifred S. Boehm Assistant in Art as Applied to Medicine 

This department is maintained for the purpose of supplying pictorial and plastic 
illustrations for visual teaching in the classrooms of the medical school and for 
publication in scientific periodicals. Research in prosthetics and the production 
of prosthetic appliances are also carried out in this department. 

Special courses of instruction are given to qualified students. 



SCHOOL OF MEDICINE 65 

BACTERIOLOGY AND IMMUNOLOGY 

Frank W. Hachtel Professor of Bacteriology and Head of the Department 

Lloyd D. Felton Visiting Research Professor of Bacteriology 

Edward Steers Associate Professor of Bacteriology 

Andrew G. Smith Assistant Professor of Bacteriology 

rL Edmund Levin Associate in Bacteriology 

Merrill J. Snyder Instructor in Bacteriology 

Joseph R. Merkel Research Assistant in Bacteriology 

Ernest C. Herrmann, Jr Research Assistant in Bacteriology 

Richard E. Brown Research Assistant in Bacteriology 

Bernard Kramer Research Assistant in Bacteriology 

Second Year. First Semester. The principles of general bacteriology are 
taught by quiz, conference, and lecture, 

Instruction given in the laboratory includes the methods of preparation of 
culture media, the study of pathogenic bacteria, and the bacteriological examina- 
tion of water and milk. The bacteriological diagnosis of communicable diseases 
is also included. 

Second Year. Second Semester. The principles of immunology are presented 
by means of quizzes, conferences and lectures. 

The course includes a consideration of infection and immunity, the nature and 
action of the various antibodies, complement fixation and flocculation tests, hyper- 
sensitiveness, and the preparation of bacterial vaccines. 

Experiments are carried out by the class in the laboratory. During the latter 
half of the semester the class is divided into sections. 

Total hours: Bacteriology 120. 
Immunology 72. 

Graduate Courses. Consult the catalogue of the Graduate School for descrip- 
tions of the graduate courses offered by members of the staff. 

BIOLOGICAL CHEMISTRY 

Emil G. Schmidt Professor of Biological Chemistry and Head of the Department 

Edward J. Herbst Assistant Professor of Biological Chemistry 

Raymond E. Vanderlinde Assistant Professor of Biological Chemistry 

William H. Summerson Lecturer in Biological Chemistry 

Ann Virginia Brown Instructor in Biological Chemistry 

Jean D. Nimmo Research Assistant in Biological Chemistry 

Eleanor B. Glinos Research Assistant in Biological Chemistry 

Dorothy D. Hubbard. . .Williams Research Corporation Fellow in Biological Chemistry 

Gerald Kessler Nutrition Foundation Fellow in Biological Chemistry 

Robert G. Leonard, B.S., M.S Bressler Reserve Fund Fellow in Biological Chemistry 

First Year. Second Semester. This course is designed to present the prin- 
ciples of biological chemistry and to indicate their applications to the clinical 
aspects of medicine. The phenomena of living matter and its chief ingredients, 
secretions and excretions are discussed in lectures and conferences and examined 
experimentally. Training is given in biochemical methods of investigation. Total 
hours: 208. 



66 UNIVERSITY OF MARYLAND 

Graduate Courses. Consult the catalogue of the Graduate School for descrip- 
tions of the graduate courses offered by members of the staff. 

CARDIOLOGY [a division of medicine] 

In the third year a series of lectures and clinics correlated with pathological 
studies is given the entire class. 

In the fourth year students are assigned for two periods weekly for five weeks 
to the Cardiac Clinic and attend consultation rounds and conferences on cardio- 
vascular cases on the Medical wards. 

CLINICAL PATHOLOGY [a division of medicine] 

Milton S. Sacks Associate Professor of Medicine and Head of 

the Division of Clinical Pathology 

Sol Smith Assistant Professor of Medicine 

Marie A. Andersch Biochemist, University Hospital, Associate in Medicine 

S. Edwin Muller Associate in Medicine 

L. Ann Hellen Instructor in Medicine 

Audrey M. Funk Instructor in Medicine 

Perry O. Futterman Instructor in Medicine 

Charles P. Barnett Baltimore Rh Laboratory Fellow in Medicine 

Third Year. First and second semesters. The course in Clinical Pathology is 
designed to train the student in the performance and interpretation of fundamental 
diagnostic laboratory procedures used in clinical medicine. 

During the first semester the work is devoted to a thorough consideration of dis- 
eases of the hematopoietic system. In the second semester, laboratory work in 
urinalysis, gastric analysis, hepatic, pancreatic and renal functions, together with 
a thorough discussion of underlying biochemical and physiological mechanisms is 
undertaken. During this semester examination of cerebrospinal fluid, transudates 
and exudates is included. Elements of clinical parasitology complete the work in 
this semester. 

Each student provides his own microscope and blood counting equipment. A 
completely equipped locker is assigned to every student. 

Total Hours: 128. 

Fourth Year. During the fourth year the student applies in the laboratories of 
the various affiliated hospitals the knowledge acquired during the preceding year. 
A completely equipped locker is assigned enabling him to work independent of 
the general laboratories. Instructors are available during certain hours to give 
necessary assistance and advice. 

DENTISTRY [a division of surgery] 

^rice M. Dorsey Professor of Oral Surgery 

x Myron S. Aisenberg Professor of Pathology 

1 Faculty Member, School of Dentistry. 



SCHOOL OF MEDICINE 67 

'Joseph C. Biddix, Jr Professor of Oral Diagnosis 

'Kyrle W. Preis Professor of Orthodontics 

'Harry M. Robinson, Sr Professor of Dermatology 

'Grayson W. Gaver Professor of Dental Prosthesis 

'Ernest B. Nuttall Professor of Crown and Bridge 

'Kenneth V. Randolph Professor of Operative Dentistry 

'Edward C. Dobbs Professor of Pharmacology 

George H. Yeager Professor of Clinical Surgery 

Grant E. Ward Associate Professor of Surgery and Oral Surgery 

'Hugh H. Hicks Associate Professor of Periodontology 

'Lewis C. Toomey Associate Professor of Oral Surgery 

George McLean Assistant Professor of Medicine 

'Wilbur O. Ramsay Assistant Professor of Clinical Dental Prosthesis 

'Samuel H. Bryant Instructor in Oral Diagnosis 

'Russell Gigliotti Instructor in Clinical Oral Diagnosis 

'Joseph P. Cappuccio Instructor in Oral Surgery 

'Conrad L. Inman Instructor in Anesthesiology 



This section has been reorganized for the teaching of both medical and dental 
students. There has been established a division in the out-patient department, 
and beds will be provided in the University Hospital, for the care of patients who 
will be available for the teaching of students from both schools. 

Senior year: clinics weekly. 

Ward instruction and group teaching are given. This includes diagnosis and 
treatment of diseases of the face, mouth and jaws. 



DERMATOLOGY AND SYPHLLOLOGY [a division of medicine] 



Harry M. Robinson, Sr Professor of Dermatology 

Francis A. Ellis Assistant Professor of Dermatology 

Harry M. Robinson, Jr Assistant Professor of Dermatology 

Eugene S. Bereston Associate in Dermatology 

A Albert Shapiro Associate in Dermatology 

Israel Zeligman Associate in Dermatology 

R. C. V. Robinson Associate in Dermatology 

William R. Bundick '.. Associate in Dermatology 

Lucile J. Caldwell Instructor in Dermatology 

Mark B. Hollander Instructor in Dermatology 

V. Harwood Link Instructor in Dermatology 

Morris M. Cohen Instructor in Dermatology 

Lee R. Lerman Assistant in Dermatology 

The third year class receives six lecture-demonstrations on the principles of 
dermatology by Dr. Robinson. 

The senior course consists of conferences and demonstrations of the common 
skin diseases and venereal diseases in the outpatient dermatologic and syphilis 
clinics and on the medical wards. 



68 UNIVERSITY OF MARYLAND 

GASTROENTEROLOGY [a division of medicine] 

Theodore H. Morrison Clinical Professor of Gastro-Enterology 

Samuel Morrison Associate Professor of Gastro-Enterology 

Maurice Feldman Assistant Professor of Gastro-Enterology 

Zachariah Morgan Assistant Professor of Gastro-Enterology 

Francis G. Dickey Associate in Medicine 

Z. Vance Hooper Associate in Gastro-Enterology 

Albert J. Shochat Instructor in Gastro-Enterology 

Philip D. Flynn Instructor in Medicine 

Alfred S. Lederman Assistant in Gastro-Enterology 

Third Year. A series of six lectures is given on the diseases of the digestive 
tract. 

Fourth Year. Students attend the gastro-intestinal clinic for two periods weekly 
for five weeks, and consultation rounds on gastro-intestinal cases on the Medical 
wards. Practical instruction is given in the use of modern methods of study of 
the diseases of the gastro-intestinal tract. 

GYNECOLOGY 

J. Mason Hundley, Jr Professor of Gynecology, and Head of the Department 

Leo Brady Assistant Professor of Gynecology 

Edward P. Smith Assistant Professor of Gynecology 

William K. Diehl Assistant Professor of Gynecology 

Everett S. Diggs Assistant Professor of Gynecology 

Beverley C. Compton Assistant Professor of Gynecology 

Ernest I. Cornbrooks, Jr Assistant Professor of Gynecology 

John C. Dumler Assistant Professor of Gynecology 

J. J. Erwin Associate in Gynecology 

Frank K. Morris. Associate in Gynecology 

Gerald A. Galvin Associate in Gynecology 

John T. Hibbitts Associate in Gynecology 

Kenneth B. Boyd Associate in Gynecology 

Theodore Kardash Instructor n Gynecology 

Charles B. Marek Instructor in Gynecology 

Thomas S. Bowyer Instructor in Gynecology 

Ernest S. Edlow Instructor in Gynecology 

W. Allen Deckert Instructor in Gynecology 

Helen I. Maginnis Instructor in Gynecology 

Charles H. Doeller, Jr Instructor in Gynecology 

William A. Dodd Instructor in Gynecology 

Harry McB. Beck Instructor in Gynecology 

William C. Duffy Instructor in Gynecology 

Joseph C. Sheehan Instructor in Gynecology 

William J. Rysanek Instructor in Gynecology 

Harry F. Kane Instructor in Gynecology 

Robert B. Tunney Instructor in Gynecology 

Thomas A. Stebbins Medical Illustrator in Oncology and Gynecology 

James H. Shell Hitchcock Fellow in Gynecology 



SCHOOL OF MEDICINE 69 

Third Year. A comprehensive course of 30 lectures in the field of gynecology, 
female urology, and female oncology is given to the entire class. 

Fourth Year. An intensive course is given to small groups of students through- 
out the year, during which time the students are assigned exclusively to this 
department. The course consists of instructions including lectures, seminars, 
ward rounds, and operative clinics. In addition, two special instruction periods 
are given in pathology at which time a review of the pathological material seen 
at operation is made with especial reference to the pathology of malignant disease. 
The students are assigned patients on the gynecological wards, and also work 
in the gynecological, cystoscopy and oncology dispensaries each day. 

Third year 30 hours 

Fourth year 75 hours 

Total: 105 hours 

HISTORY OF MEDICINE 
Louis A. M. Krause Professor of Clinical Medicine 

Beginning with the spring of 1942 a group of lectures on the history of medicine 
has been presented on selected phases and trends of the development of medical 
knowledge and practice. It is planned to avoid duplication of subject matter 
for at least four years. 

These lectures are offered primarily for our students, but a cordial invitation 
is extended to anyone who may wish to attend. 

Announcement of the lectures will be made by mail and on the bulletin 
board of the School of Medicine. 

HYGIENE AND PUBLIC HEALTH [a division of medicine] 

Huntington Williams Professor of Hygiene and Public Health 

William H. F. Warthen Associate Professor of Hygiene and Public Health 

Ross Davtes Associate Professor of Hygiene and Public Health 

Third Year. A one-hour lecture is given to the whole class each Tuesday during 
both semesters. Basic instruction is afforded in the clinical and public health 
aspects of the communicable diseases including syphilis and tuberculosis. The 
lectures are under the auspices of the Department of Medicine and are given by 
staff members of that department, including physicians representing pediatrics, 
hygiene and public health, and by staff members of the Baltimore City Health 
Department. 

Fourth Year. Elective work is also assigned at the Western Health District 
Building of the City Health Department, 617 West Lombard Street, where the 
District Health Officer arranges for home visiting and the student prepares and 
presents a Home Survey Report. 

The course deals with the fundamentals of public health and supplements the 
work in the third year. The major emphasis in both years is on the practice of 



70 UNIVERSITY OF MARYLAND 

preventive medicine and the relation of prevention to diagnosis and treatment, 
and on the civic and social implications of the medical services. 

INDUSTRIAL MEDICINE AND SURGERY [a division of surgery] 

Professor of Clinical Medicine 

Charles A. Reifschneider Clinical Professor of Traumatic Surgery 

Thurston R. Adams Assistant Professor of Surgery 

This section is under the combined supervision of the medical and surgical 
departments. It is a cooperative effort by members of the medical school and 
hospital staff to afford means for clinical and laboratory study of the patient who 
has been subjected to traumatic or medical industrial hazard, so that adequate 
care may be instituted to promote his physical well-being. The faculties of the 
laboratories of the medical school and hospital are available as required. 

Under direction of this department limited undergraduate instruction is given, 
especially in the methods of examination and of keeping records and in the general 
medico-legal principles as they affect the industrial employee, the employer, the 
general insurers, the physician and the hospital. There is also instruction on 
methods of making life insurance and other physical examinations, whether for 
employment or for health purposes. The wards of the University, Mercy and 
Baltimore City Hospitals provide for bed-side instruction. 

Total hours: 8. 

LEGAL MEDICINE [a division of medicine] 

Russell S. Fisher Associate Professor of Legal Medicine 

Henry C. Freimuth Associate in Legal Medicine 

Stanley H. Durlacher Associate in Legal Medicine 

William J. McClafferty Associate in Legal Medicine 

William V. Lovttt, Jr Instructorin Legal Medicine 

Third Year. This course embraces a summary of medical jurisprudence in- 
cluding the laws governing the practice of medicine, industrial compensation 
and malpractice, proceedings in criminal and civil prosecution, medical evidence 
and testimony, identification of bodies, injuries by blunt force, gunshot and other 
mechanisms, natural and homicidal deaths, medicolegal toxicology and the medico- 
legal autopsy. (12 hours.) 

Elective Course (summer). A small number of students may upon application 
be assigned to elective work in the laboratory of the Chief Medical Examiner of 
the State of Maryland. 

MEDICINE 

Maurice C. Pincoffs Professor of Medicine and Head of the Department 

T. Nelson Carey Professor of Clinical Medicine 

Thomas P. Sprunt Professor of Clinical Medicine 

H. Raymond Peters Professor of Clinical Medicine 

Louis A. M. Krause Professor of Clinical Medicine 

William S. Love, Jr Associate Professor of Medicine 



SCHOOL OF MEDICINE 71 

Thomas C. Wolff Associate Professor of Medicine 

Howard M. Bubert Associate Professor of Medicine 

J. Sheldon Eastland Associate Professor of Medicine 

Milton S. Sacks Associate Professor of Medicine 

Lewis P. Gundry Associate Professor of Medicine 

Samuel Morrison Associate Professor of Medicine 

Theodore E. Woodward Associate Professor of Medicine 

William H. Smith Associate Professor of Clinical Medicine 

George McLean Assistant Professor of Medicine 

Wetherbee Fort Assistant Professor of Medicine 

Frank J. Geraghty Assistant Professor of Medicine 

H. Vernon Langeltjttig Assistant Professor of Medicine 

Sol Smith Assistant Professor of Medicine 

Edward F. Cotter Assistant Professor of Medicine 

C. Edward Leach Assistant Professor of Medicine 

Ephraim T. Lisansky Assistant Professor of Medicine 

Samuel T. R. Revell, Jr Assistant Professor of Medicine 

Henry J. Marriott Assistant Professor of Medicine 

Robert A. Reiter Assistant Professor of Medicine 

Samuel Legum Associate in Medicine 

W. Grafton Herspberger Associate in Medicine 

Meyer W. Jacobson Associate in Medicine 

Conrad B. Acton Associate in Medicine 

Francis G. Dickey Associate in Medicine 

Lawrence M. Serra Associate in Medicine 

Marie A. Anderesch Associate in Medicine and Lecturer in Biological Chemistry 

Harry M. Robinson, Jr Associate in Medicine 

William K. Waller Associate in Medicine 

Arthur Karfgin Associate in Medicine 

M. Paul B yerly Associate in Medicine 

Henry W. D. Holljes. Associate in Medicine 

S. Edwin Muller Associate in Medicine 

Sidney Scherlis Associate in Medicine 

Kurt Levy. Associate in Medicine 

Wilfred H. Townshend Associate in Medicine 

Alvin J. Hartz Associate in Medicine 

James R. Karns Associate in Medicine 

Edmund G. Beacham Associate in Medicine 

Richard A. Carey Associate in Medicine 

Louis V. Blum Associate in Medicine 

Leon Ashman Associate in Medicine 

Louis Kroll Associate in Medicine 

Daniel Wilfson, Jr Associate in Medicine 

Jonas Cohen Associate in Medicine 

Walter Karfgln Associate in Medicine 

Irving Freeman Associate in Medicine 

Philip D. Flynn Instructor in Medicine 

Edward S. Kallins Instructor in Medicine 

John A. Myers Instructor in Medicine 



72 



UNIVERSITY OF MARYLAND 



William G. Helfrich Instructor 

Joseph E. Muse Instructor 

William H. Kammer, Jr Instructor 

Samuel J. Hankin Instructor 

Frederick J. Vollmer Instructor 

John R. Davis Instructor 

John B. deHoff Instructor 

Charles F. Brambel Instructor 

L. Ann Hellen Instructor 

Audrey M. Funk Instructor 

J. Emmett Queen Instructor 

Leon A. Kochman Instructor 

Robert E. Bauer Instructor 

C. Herman Williams Instructor 

Jerome Sherman Instructor 

Perry 0. Futterman Instructor 

Elizabeth D. Sherrill Instructor 

Philip D. Flynn Instructor 

Joseph Furnari Instructor 

Robert T. Parker Instructor 

Morris Fine Instructor 

Stephen J. Van Lill, III Instructor 

Stuart D. Sunday Instructor 

Irvin B. Kemick Instructor 

Maurice Feldman, Jr Instructor 

James J. Nolan Instructor 

Charles E. Shaw Instructor 

Joseph G. Bird Instructor 

Rollin C. Hudson Assistant 

Franklin E. Leslie Assistant 

John C. Osborne Assistant 

Raymond M. Lauer Assistant 

Lauriston L. Keown Assistant 

Burton V. Lock Assistant 

Carl F. Myers Assistant 

Jack Wexler Assistant 

Bernard Burgin Assistant 

Marvin Goldstein Assistant 

Donald Mintzer Assistant 

Franklin Leslie Assistant 

Joseph C. Myers Assistant 

Thomas Worsley Assistant 

Edward S. Kallins Assistant 

Joseph B. Workman Research Fellow 

Charles P. Barnett Baltimore Rh Typing Laboratory Fellow 



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Second Year 
Introduction to clinical medicine. 

(a) Introductory physical diagnosis. (1 hour a week, first semester; 2 hours a week, 

second semester.) 

(b) Medical clinics. (1 hour a week, second semester.) 



SCHOOL OF MEDICINE 73 

Third Year 

I. The methods of examination: (a) History taking, (b) Physical diagnosis, (c) 
Clinical pathology. 
Instruction includes lectures and practice in the wards, outpatient department and 
laboratory. 
II. The principles of medicine: 

(a) Lectures, clinics and demonstrations in general medicine, neurology, and pre- 
ventive medicine. 
Third Year teaching of physical diagnosis is carried out chiefly in the various units 
of the City Hospital. 

Fourth Year 
The practice of medicine : 
I. Clinical clerkship on the medical wards (31 hours a week for ten weeks). 

(a) Responsibility, under supervision, for the history, physical examination, 

laboratory examinations and progress notes of assigned cases. 

(b) Ward classes, ward rounds and conferences in general medicine, the medical 

specialties, and therapeutics. 
II. Dispensary work in the medical specialties. 
III. Clinical-pathological conferences (1 hour a week). 

The medical dispensary of the University Hospital is utilized for teaching in the 
third year. Each student spends two hours daily for ten weeks in dispensary work. 
The work is done in groups of four to six students under an instructor. Systematic 
history-taking is especially stressed. Physical findings are demonstrated. The 
student becomes familiar with the commoner acute and chronic disease processes. 

Clinical clerkships in the Fourth Year are served on the medical wards of both 
the University and Mercy Hospitals. 

NEUROLOGICAL SURGERY [a division of surgery] 

Charles Bagley, Jr Professor of Neurological Surgery 

Richard G. Coblentz Professor of Clinical Neurological Surgery 

James G. Arnold, Jr Associate Professor of Neurological Surgery 

John A. Wagner Associate Professor of Pathology and Neuropathology 

Robert Oster 

Associate in Electro-physiology, and Director of the Hoffberger Electroencephalo- 

graphic Laboratory 
Raymond K. Thompson 

Associate in Neurological Surgery, Director of Neurological Surgery Research 

Frank J. Otenasek Instructor in Neurological Surgery 

John W. Chambers Instructor in Neurological Surgery 

Louis O. J. Manganiello 

Research Fellow, Fund B, assigned to Neurological Surgery, Exchange Resident 

in Neurosurgery, Baltimore City Hospitals 

Robert M. N. Crosby Fellow in Neurological Surgery 

Pomeroy Nichols, Jr Fellow in Neurological Surgery 

Third year. The course covers instruction in diagnosis and treatment of 
surgical conditions of the brain, spinal cord and the peripheral nerves. Drs. 
Bagley, Coblentz, Arnold and Thompson. 



74 UNIVERSITY OF MARYLAND 

Fourth year. Weekly ward rounds and conferences are given at the University 
Hospital. Drs. Bagley, Coblentz, Arnold and Thompson. Instruction is given 
(elective) in the out-patient dispensary by Drs. Louis Manganiello, George Smith 
and Jose A. Alvarez. 

Third year 12 hours 

Fourth year 15 hours 

Conference and ward rounds (elective) 32 hours 

Neurological Surgery Dispensary (elective) 48 hours 

Total 107 hours 

NEUROLOGY 

Leon Freedom Associate Professor of Neurology 

Philip F. Lerner Assistant Professor of Neurology 

William L. Fearing Associate in Neurology 

Edward F. Cotter Associate in Neurology 

Harry Teitelbaum Associate in Neurology 

George G. Merrill Associate in Neurology 

Second Year. Fifteen one-hour lectures are given to correlate the anatomy 
and physiology of the nervous system with clinical neurology. 

Third Year. Twenty hours of instruction are given to the whole class in neuro- 
pathology supplemented with pathological demonstrations. Sixteen lecture- 
demonstrations are given in which the major types of the diseases of the nervous 
system are discussed. A course is also given at the Baltimore City Hospitals, 
comprising eight periods of two hours each, in which the students in small groups 
carry out complete neurological examinations of selected cases which illustrate 
the chief neurological syndromes. 

Fourth Year. Fourth year students in the Medical section attend neurological 
consultation rounds on ward patients in the University and Mercy Hospitals. 
All patients presented at these clinics are carefully examined. 

Dispensary Instructions. Small sections are instructed in the neurological dis- 
pensary of the Mercy Hospital five afternoons each week. In this way students 
are brought into contact with nervous diseases in their early and late manifesta- 
tions. 

OBSTETRICS 

Louis H. Douglass Professor of Obstetrics and Head of the Department 

J. Morris Reese Associate Professor of Obstetrics 

D. Frank Kaltreider Associate Professor of Obstetrics 

Isadore A. Siegel Assistant Professor of Obstetrics 

John E. Savage '. Assistant Professor of Obstetrics 

Hugh B. McNally Assistant Professor of Obstetrics 

Margaret B. Ballard Associate in Obstetrics 

D. McClelland Dixon Associate in Obstetrics 

Osborne C. Christensen Associate in Obstetrics 

J. Tyler Baker Associate in Obstetrics 

J. Huff Morrison Associate in Obstetrics 

George H. Davis Instructor in Obstetrics 

J. King B. E. Seegar Instructor in Obstetrics 



SCHOOL OF MEDICINE 75 

Louis C. Gareis Instructor in Obstetrics 

Kenneth B. Boyd Assistant in Obstetrics 

W. Kenneth Mansfield, Jr Assistant in Obstetrics 

Charles H. Doeller, Jr Assistant in Obstetrics 

Theodore Kardash Assistant in Obstetrics 

Harry McB. Beck Assistant in Obstetrics 

William A. Dodd Assistant in Obstetrics 

Irvin P. Klemkowski Assistant in Obstetrics 

Clarence W. Martin Assistant in Obstetrics 

Vernon C. Kelley Assistant in Obstetrics 

Harry Cohen Assistant in Obstetrics 

Second Year: During the second semester lectures are given one hour weekly. 
Students are oriented on the normal pelvis, generative tract and the physiology 
of pregnancy and labor. The conduct of normal delivery and the puerperium are 
explained, and in general an attempt is made to prepare the student for the prac- 
tical training he is to receive in his third year. Drs. Douglass and Kaltreider. 

Third Year: Lectures and recitations consist of 3 hours teaching weekly and 
are designed to cover the anatomy more completely, especially that of the bony 
pelvis from an obstetrical point of view. Physiology of the endocrine system is 
reviewed as it relates to pregnancy and the growth and development of the im- 
pregnated ovum. Following this the pathology of pregnancy, labor and the puer- 
perium are considered. Drs. Douglass, Reese, Siegel, Savage, Dixon and 
Kaltreider. 

Each student is required to spend 4 days on the obstetrical service of the Balti- 
more City Hospitals during his junior year. Here he acts as a junior intern, ob- 
serving, assisting and finally delivering normal cases under supervision. Each 
student attends a total of about 25 deliveries, in the majority of which he takes an 
active part. 

Each student receives, as a member of a small group, 10 hours of instruction in 
palpating patients, in the clinical evaluation of the pelvis and in demonstrations 
of the mechanism of labor. Drs. Siegel and McNally. 

Fourth Year: The instruction is entirely clinical. The "block system" is used. 
One-sixteenth of the class is assigned to obstetrics only for a period of 2 weeks. 
Students live at the University Hospital during this time and are on call 24 hours 
a day. They receive formal class instruction, are required to attend all rounds 
and staff conferences and are present at the majority of the deliveries as observers, 
assistants or as accoucheurs. In this way each student will actively participate 
in about 15 deliveries. Operative work on an obstetrical mannikin is an organized 
part of the course. Each student receives 6 hours of this type of instruction. 

Each student spends 20 hours in the prenatal and postnatal clinics, where in- 
structions in these fields are given. 

Students assigned to obstetrics are required to attend the monthly meetings of 
The Committee on Maternal Mortality of Baltimore, where all maternal deaths 
occurring in this city are presented and discussed. 

Second year — 16 Third year — 148 

Fourth year— 106 Total —270 



76 UNIVERSITY OF MARYLAND 

ONCOLOGY [a division of gynecology and surgery] 

J. Mason Hundley, Jr Professor of Gynecology 

Beverley C. Compton Assistant Professor of Gynecology 

William K. Diehl Assistant Professor of Gynecology 

Everett S. Diggs Assistant Professor of Gynecology 

Ernest I. Cornbrooks, Jr Assistant Professor of Gynecology 

Arthur G. Si vvinski Assistant Professor of Surgery 

John C. Dumler Assistant Professor of Gynecology 

Edwin H. Stewart Associate in Surgery 

J. Duer Moores Instructor in Surgery 

Louis F. Goodman Instructor in Surgery 

Girardo B. Polanco National Cancer Institute Trainee in Pathology 

E. Eugene Covington Assistant Radiologist 

Thomas A. Stebbins Medical Illustrator in Oncology and Gynecology 

The purpose of the courses in Oncology is to give students training in the 
diagnosis and treatment of neoplastic diseases not obtained in other departments 
and at the same time to correlate this training with that received in surgery, 
medicine, roentgenology and other specialties. 

Third year. Six didactic lectures are given on the diagnosis and treatment of 
cancer of the generative organs. Dr. Hundley and staff. 

Five lectures in general oncology are given to the entire Junior Class at the end 
of the year. The increasing importance of the cancer problem is emphasized. 
The biological aspects of cancer and the relation of hormones, carcinogenic agents, 
and etiological factors are discussed. The gradation of neoplasms, and the bio- 
physical effects of irradiation therapy are presented. The diagnosis, surgical 
and radiological treatment of neoplasms of the head and neck, oral cavity, skin, 
breasts, and hemopoietic system are discussed. Dr. Ward and staff. 

Fourth Year. Ten senior students of the University section are assigned to the 
Oncology clinic. Five students are assigned to the Tuesday morning clinic, and 
the alternate group to the Friday morning clinic. The diagnosis and treatment, 
both surgical and radiological are discussed in the presence of a staff member of 
the departments of Pathology, Radiology, and Surgery. 

An outpatient Gynecological Clinic is held bi-weekly which affords an opportu- 
nity for instruction of small groups of students, which are assigned in rotation, in 
the various phases of malignancy of the generative organs. Weekly ward rounds 
and operative clinics are held for seniors. 

Onocology Gynecology Total 

Third year '. 5 hours 6 hours 1 1 hours 

Fourth year 12 hours 16 hours 28 hours 

Total 17 hours 22 hours 39 hours 

OPHTHALMOLOGY 

F. Edwin Knowles, Jr. 

Assistant Professor of Ophthalmology and Chairman of the Department 



SCHOOL OF MEDICINE 77 

Joseph I. Kemler Associate in Ophthalmology 

A. Kremen Associate in Ophthalmology 

Paul N. Friedman Instructor in Ophthalmology 

Ruby A. Smith Instructor in Ophthalmology 

D. J. McHenry Instructor in Ophthalmology 

F. E. Brtjmback Instructor in Ophthalmology 

Richard J. Cross Instructor in Ophthalmology 

John C. Ozazewski Assistant in Ophthalmology 

Third Year. Second semester. Dr. Friedman reviews the anatomy and physi- 
ology of the eye and discusses the methods used in making the various exami- 
nations. Errors of refraction and their effect upon the general system are explained. 
Weekly section work, demonstrating the use of the ophthalmoscope, with the aid 
of kodachrome transparencies of the fundus oculi is carried on during the entire 
session at the Baltimore Eye, Ear, and Throat Hospital by Dr. Kremen. 

Fourth Year. Clinics and demonstrations are given in diseases of the eye, 
twice weekly, for one year. Dr. Knowles. 

The course consists of instruction in the clinic to small groups of students four 
days a week for four weeks. During this period, the student examines patients, 
diagnoses and treats various ocular diseases, under the supervision of Drs. Knowles, 
Smith, Brumback, Friedman and Ozazewski. Twice weekly lectures and lantern 
slide demonstration are given upon diseases of the eye, with particular reference 
to their diagnosis, management and relation to general medicine. Special lec- 
tures are given the entire class on vascular changes in the eye, refraction, cata- 
ract and neuro-ophthalmology. Certain operations are demonstrated by motion 
pictures. 

Weekly ward classes are held at the University and Mercy Hospitals during 
which the eye grounds in the various medical and surgical conditions are demon- 
strated. Drs. Knowles, Kemler, Kremen, Smith, Brumback, Jeppi and Pacienza. 

Third year 20 hours 

Fourth year 41 hours 

Total 61 hours 

ORTHOPAEDICS [a division of surgery] 

Allen Fiske Voshell Professor of Orthopaedic Surgery 

Harry L. Rogers Clinical Professor of Orthopaedic Surgery 

Moses Gellman .Associate Professor of Orthopaedic Surgery 

Henry F. Ullrich Associate Professor of Orthopaedic Surgery 

Milton J. Wilder Assistant Professor in Orthopaedic Surgery 

I. H. Maseritz Associate in Orthopaedic Surgery 

Jason H. Gaskel Instructor in Orthopaedic Surgery 

Isaac Gutman Instructorin Orthopaedic Surgery 

James P. Miller Instructor in Orthopaedic Surgery 

Everett D. Jones Assistant in Orthopaedic Surgery 

Robert C. Abrams Assistant in Orthopaedic Surgery 

Didactic instruction is given in the second, third and fourth years. Clinical, 



78 UNIVERSITY OF MARYLAND 

bedside and outpatient instruction is given at the University, Mercy Hospitals 
and their Outpatient Departments, Kernan Hospital for Crippled Children, and 
Baltimore City Hospitals. Brief discussions and demonstrations of physical and 
occupational therapy are included in the course. 

Second year 19 hours 

Third year 36 hours 

Fourth year 90 hours 

Total 145 hours 

OTOLARYNGOLOGY [a division of surgery] 

Edward A. Looper Professor of Otolaryngology and Head of the Department 

Waitman F. Zinn Professor of Otolaryngology 

Thomas R. O'Rourk Professor of Otolaryngology 

Frederick T. Kyper Associate Professor of Otolaryngology 

Benjamin S. Rich Associate Professor of Otolaryngology 

Fayne A. Kayser Associate Professor of Otolaryngology 

W. Raymond McKenzee Assistant Professor of Otolaryngology 

Theodore A. Schwartz Assistant Professor of Otolaryngology 

Robert Z. Berry Associate in Otolaryngology 

Arthur Ward Associate in Otolaryngology 

John H. Herschfeld Assistant in Otolaryngology 

Benjamin H. Isaacs Associate in Otolaryngology 

Samuel L. Fox Associate in Otolaryngology 

Richard J. Cross Instructor in Otolaryngology 

Third Year. Instruction to the whole class is given in the common diseases of 
the nose and throat, attention being especially directed to infections of the accessory 
sinuses, the importance of focal infections in the etiology of general diseases and 
modern methods of diagnosis. Lectures illustrated by lantern slides are given 
one hour weekly for eight weeks by Dr. Looper. 

Fourth Year. Dispensary instruction is given for three hours daily, to small 
sections at the University and the Mercy Hospitals. The student is afforded an 
opportunity to study, diagnose and treat patients under supervision. Ward classes 
and clinical demonstrations are given in periods of one and one-half hours weekly 
throughout the session in the University and Mercy Hospitals. 

The Looper Clinic for bronchoscopy and esophagoscopy, recently established 
in the University Hospital, affords unusual opportunities for students to study 
diseases of the larynx, bronchi and esophagus. The clinic is open to students 
daily from 2 to 4 P.M. under direction of Dr. Looper, and associates. 

The Mercy Hospital clinic for bronchoscopy and esophagoscopy is under the 
direction of Dr. Zinn. In these two clinics the etiology, symptomatology, diag- 
nosis and treatment of foreign bodies in the air and food passages, as well as 
bronchoscopy, are taught to students as an aid in the diagnosis and treatment of 
diseases of the lungs. 

Third year 9 hours 

Fourth year 53 hours 

Total 62 hours 



SCHOOL OF MEDICINE 79 

OTOLOGY [a division of surgery] 

Thomas R. O'Rourk Professor of Otolaryngology 

The course in otology is planned to give a practical knowledge of the anatomy 
and physiology of the ear, and its proximity and relationship to the brain and other 
vital structures. The inflammatory diseases, their etiology, diagnosis, treatment 
and complications are particularly stressed, with emphasis upon their relationship 
to the diseases of children, head-surgery and neurology 

Third Year. The whole class is given instruction by means of talks, anatomical 
specimens and lantern slides. Dr. O'Rourk and associates. 

Fourth Year. Small sections of the class receive instruction and make personal 
examinations of patients under the direction of an instructor. The student is 
urged to make a routine examination of the ear in his ward work in general medi- 
cine and surgery. Dr. O'Rourk and associates. 

Third year 12 hours 

Fourth year . 40 hours 

Total 52 hours 

PATHOLOGY 

Hugh R. Spencer Professor of Pathology and Head of the Department 

Robert B. Wright Associate Professor of Pathology 

C. Gardner Warner Associate Professor of Pathology 

Walter C. Merkel Associate Professor of Pathology 

Dexter L. Reimann Associate Professor of Pathology 

John A. Wagner Associate Professor of Pathology 

Albert E. Goldstein Assistant Professor of Pathology 

Milton S. Sacks Associate in Pathology 

Benedict Skitarelic Associate in Pathology 

Charles P. Barnett Associate in Pathology 

Conrad B. Acton Instructor in Pathology 

Howard B. Mays Instructor in Pathology 

Ephraim T. Lisansky Instructor in Pathology 

D. McClelland Ddcon Instructor in Pathology 

William B. VandeGriet Instructor in Pathology 

William J. Bryson Instructor in Pathology 

Karl F. Mech Instructor in Pathology 

Seymour W. Rubin Instructor in Pathology 

Theodore Kardash Instructor in Pathology 

Louis C. Gareis Instructor in Pathology 

Roy B. Turner Instructor in Pathology 

Edward L. J. Kreig Instructor in Pathology 

James H. Ramsey Assistant in Pathology 

Harry Cohen Assistant in Pathology 

Gerardo B. Polanco National Cancer Institute Trainee 

Courses of instruction in pathology are given during the second and third years. 
The courses are based on the previous study of normal structure and function and 
aim to outline the history of disease. The relationship between clinical symptoms 
and anatomical lesions is constantly stressed. 



80 UNIVERSITY OF MARYLAND 

General Pathology. Second Semester, Second Year. This course includes 
the study of disturbances of the body fluids; disturbances of structure, nutrition 
and metabolism of cells; disturbances of fat, carbohydrate and protein metab- 
olism; disturbances of pigment metabolism; inflammation and tumors. 

Laboratory instruction is based on the study of prepared slides (loan collection) 
and corresponding gross material. 

Applied Pathology, Including Gross Morbid Anatomy and Morbid 
Physiology. Third Year. The laboratory instruction in this course is carried 
out in small teaching museums where prepared specimens and material from au- 
topsies with clinical histories and sections are available for study. For this work 
the class is divided into small groups. Clinical correlation is stressed. 

Autopsies. Third Year. Students in small groups attend autopsies at the 
morgues of the University Hospital and the Baltimore City Hospitals. 

Clinical-Pathological Conference. {Fourth Year.) These exercises are 
held in collaboration with the various clinical departments. Selected cases are 
discussed and autopsy findings are presented. 

Second year 184 hours 

Third year 160 hours 

Fourth year 30 hours 

Total 374 hours 

PEDIATRICS 

J. Edmund Bradley Professor of Pediatrics and Head of the Department 

C Lortng Joslin Professor of Pediatrics 

A. H. Finkelstein Associate Professor of Pediatrics 

Frederick B. Smith Associate Professor of Pediatrics 

Gordon E. Gibbs Associate Professor Clinical Research 

Albert Jaffe Associate Clinical Professor of Pediatrics 

Samuel S. Glick Assistant Professor of Pediatrics 

Jerome Fineman Assistant Professor of Pediatrics 

Gibson J. Wells Assistant Professor of Pediatrics 

William M. Seabold Assistant Professor of Pediatrics 

Clewell Howell Associate in Pediatrics 

G. Bowers Mansdorfer Associate in Pediatrics 

Arnold F. Lavenstein Instructor in Pediatrics 

Mary L. Hayleck Instructor in Pediatrics 

Israel P. Meranski '. Instructor in Pediatrics 

Melchijah Spragins Instructor in Pediatrics 

Thomas A. Christensen Instructor in Pediatrics 

Joseph M. Cordi Instructor in Pediatrics 

William Earl Weeks Assistant in Pediatrics 

J. Carlton Wich Assistant in Pediatrics 

O. Walter Spurrler Assistant in Pediatrics 

Lestek Caplan Assistant in Pediatrics 

A. Maynard Bacon, Jr Assistant in Pediatrics 

Sara Cook Assistant in Pediatrics 

Ruth Baldwin Assistant in Pediatrics 

A. Maynard Bacon, Jr. 6 Assistant in Pediatrics 



SCHOOL OF MEDICINE 81 

Melvin N. Borden Assistant in Pediatrics 

Howard Goodman Assistant in Pediatrics 

Richard A. Young Research Assistant in Pediatrics 

Margaret Lucille Ward Research Assistant in Pediatrics 

Third Year. The course is presented as follows: 

Lectures on infant feeding and the fundamentals of diseases of infants and 
children. (15 hours.) 

Lectures on contagious diseases in conjunction with the Department of 
Hygiene and Preventive Medicine. (14 hours.) 

A special course in physical diagnosis is given at City Hospitals. (20 hours.) 

Clinical conferences demonstrating diseases of the new-born. (6 hours.) 

Fourth Year. A clinic in the amphitheatre is given at which time patients are 
shown demonstrating the features of the diseases discussed. (30 hours.) 

Conferences and demonstrations are given in problems of diagnosis, care, treat- 
ment and clinical pathology of diseases of infants and children. (30 hours.) 

Students are assigned subjects on which to prepare theses. 

Clinical clerkships are assigned on the pediatric wards, where experience is 
gained in taking histories, making physical examinations, doing routine laboratory 
work, and following up patients' progress. This is under the supervision of the 
visiting staff. (140 hours.) 

Instruction is given in the pediatric clinic of the out-patient department of 
the University Hospital. This consists of 1J hours daily for five weeks — 30 
minutes each day is devoted to a clinical demonstration of some interesting case 
by a member of the staff; one hour daily to taking histories and making physical 
examinations under the supervision of an instructor. (45 hours.) 

Total hours: 300. 

PHARMACOLOGY 

John C. Krantz, Jr Professor of Pharmacology and Head of the Department 

C. Jelleff Carr Professor of Pharmacology 

Raymond M. Burgison Assistant Professor of Pharmacology 

Ruth Musser Instructor in Pharmacology 

Joseph G. Bird Assistant in Pharmacology 

Amedeo S. Marrazzi Lecturer in Pharmacology 

William G. Harne Demonstrator in Pharmacology 

Frederick K. Bell Fellow in Pharmacology 

Mary S. Fassel Emerson Fellow in Pharmacology 

John B. Harmon Emerson Fellow in Pharmacology 

Go Lu Fellow in Pharmacology 

Leonard S. Brahen Eli Lilly Fellow in Pharmacology 

Johnson S. L. Ling Eli Lilly Fellow in Pharmacology 

This course is designed to include those phases of pharmacology necessary for 
an intelligent use of drugs in the treatment of disease. The didactic instruction 
includes materia medica, pharmacy, prescription-writing, toxicology, posology, 
pharmacodynamics, and experimental therapeutics. The laboratory exercises 
parallel the course of lectures. 



82 



UNIVERSITY OF MARYLAND 



In addition, optional conference periods and lectures are available for students 
desiring further instruction or advice. 

Total hours: 216. 

Graduate Courses. Consult the catalogue of the Graduate School for descrip- 
tions of the graduate courses offered by members of the staff. 



PHYSICAL DIAGNOSIS [a division of medicine] 



T. Conrad Wolfe 

Associate Professor of Medicine, and Head of the Division of Physical 

Robert A. Reiter Assistant Professor of 

Samuel Legum Associate in 

Grafton Hersperger Associate 

Edmund G. Beacham Associate 

Louis Kroll Associate 

Daniel Wilfson Associate 

Leon Ashman Associate 

Joseph Muse Instructor 

Samuel Hankxn Instructor 

John B. DeHoff Instructor 

William G. Helfrich Instructor 

Leon A. Kochman Instructor 

Stuart D. Sunday Instructor 

Elizabeth D. Sherrill Instructor 

Stephen J. Van Lill, III Instructor 

Franklin Leslie Assistant 

Thomas Worsley Assistant 

Lauriston Keown Assistant 

Jack Wexler Assistant 

Carl F. Myers Assistant 

Bernard Burgin Assistant 



Diagnosis 
Medicine 
Medicine 
Medicine 
Medicine 
Medicine 
Medicine 
Medicine 
Medicine 
Medicine 
Medicine 
Medicine 
Medicine 
Medicine 
Medicine 
Medicine 
Medicine 
Medicine 
Medicine 
Medicine 
Medicine 
Medicine 



The course in physical diagnosis starts with the first semester of the Sophomore 
year and ends with the termination of the second semester of the Junior year. 

First Semester — Second Year — Lecture, one hour weekly covering the technique 
of history writing and the mechanics of the physical signs elicited in the normal 
person through inspection, palpation, percussion and auscultation. 

Second Semester — Second Year — Lecture, one hour weekly, covering the tech- 
nique of history writing in cases involving disease, and the mechanics of patho- 
logical physical signs on inspection, palpation, percussion and auscultation. 

In the third and fourth quarters small tutorial groups are formed, each under 
the direction of an instructor. Experience in physical examination of normal indi- 
viduals is given in the third quarter for one afternoon weekly. In the fourth 
quarter the students become acquainted with abnormal signs through examination 
of hospital patients. 

Third Year — a. The class is divided into four sections. Each section receives 
bedside instruction in physical diagnosis for seven weeks (2 hrs. daily). For this 
purpose small groups under an instructor are formed. The instruction is carried 



SCHOOL OF MEDICINE 83 

on in the Baltimore City Hospitals but in addition advantage is occasionally taken 
of the clinical opportunities in other institutions. 

b. Lecture course (1 hr. weekly for 15 weeks) covering the mechanisms of ab- 
normal signs. 

PHYSIOLOGY 

William R. Amberson Professor of Physiology and Head of the Department 

Dietrich C. Smith Professor of Physiology 

Frederick P. Ferguson Associate Professor of Physiology 

J. McCullough Turner Associate Professor of Physiology 

Harold E. Himwich Lecturer in Physiology 

Samuel L. Fox Instructor in Physiology 

Sylvia Hlmmelfarb Assistant in Physiology 

Frances C. Brown Assistant in Physiology 

Jeanne Ann Qulnlin Assistant in Physiology 

John I. White U.S.P.H. Fellow in Physiology 

Richard F. C. Egan John F. B. Weaver Fellow in Physiology 

Annemarte Weber U.S.P.H. Research Fellow in Physiology 

Carolyn F. Hendrickson Research Assistant in Physiology 

The course in physiology is given in two parts: 

First Year. Second Semester. Neuro-muscular physiology is presented in 
two lectures a week, without laboratory work. 

Second Year. First Semester. The remainder of the subject is presented in 
four lectures, one conference, and two laboratory periods a week. 

The fundamental concepts of physiology are presented with special reference 
to mammalian problems. 

Total hours: 224. 

Graduate Courses. Consult the catalogue of the Graduate School for descrip- 
tions of the graduate courses offered by members of the staff. 

PLASTIC SURGERY [a division of surgery] 

Edward A. Kitlowski Clinical Professor of Plastic Surgery 

Clarence P. Scarborough Instructor in Plastic Surgery 

Walter J. Benavent Assistant in Plastic Surgery 

This course is designed to acquaint students with the problems of reconstruc- 
tive and plastic surgery. A subdivision in the dispensary has been established 
and beds for patients will be available for instruction in this course at the Univer- 
sity and Baltimore City Hospitals and Kernan's Hospital for Crippled Children. 

Third Year. Five lectures are given to the whole class. Dispensary instruction 
is provided on Mondays and Fridays. 

Fourth Year. Ward rounds and operative demonstrations are held at the 
hospitals. 

PROCTOLOGY [a division or surgery] 

Monte Edwards Professor of Proctology 

Thurston R. Adams Assistant Professor of Proctology 

Simon H. Brager Assistant Professor of Proctology 



84 UNIVERSITY OF MARYLAND 

Donald B. Hebb Instructor in Proctology 

William T. Supik Instructor in Proctology 

Raymond M. Cunningham Instructor in Proctology 

Third Year. Seven lectures are given to the whole class. The course is for 
instruction in the diseases of the colon, sigmoid flexure, rectum and anus, and 
covers the essential features of the anatomy and physiology of the large intestine 
as well as the various diseases to which it is subject. Dr. Monte Edwards. 

Fourth Year. Ward and dispensary instruction is given in the University and 
Mercy Hospitals, where different phases of the various diseases are taught by 
direct observation and examination. The use of the proctoscope and sigmoido- 
scope in the examination of the rectum and sigmoid is made familiar to each stu- 
dent. Mercy Hospital — Drs. Supik and Brager. University Hospital — Drs. 
Monte Edwards and Adams. 

Third year 7 hours 

Fourth year 16 hours 

Total 23 hours 

PSYCHIATRY 

Jacob E. Finesinger Professor of Psychiatry and Head of the Department 

John R. Redd Visiting Professor of Psychiatry 

H. Whitman Newell Associate Professor of Psychiatry 

Harry M. Murdock Assistant Professor of Psychiatry 

Philip S. Wagner Assistant Professor of Psychiatry 

Hans W. Loewald Assistant Professor of Psychiatry 

William W. Elgin Assistant Professor of Psychiatry 

J. G. N. Cushing Assistant Professor of Psychiatry 

Kathryn L. Schdltz Assistant Professor of Psychiatry 

Robert G. Grenell Assistant Professor of Psychiatric Research 

Isadore Tuerk Associate in Psychiatry 

Ephralm T. Lisansky Associate in Psychiatry 

Kathryn Dice Associate in Clinical Psychology 

Elizabeth LaForge Associate in Psychiatric Social Work 

Moritz Michaelis Research Associate in Biochemistry 

Harold E. Himwich Lecturer in Psychiatry 

A. Russell Anderson Instructor in Psychiatry 

Francis J. McLaughlin Instructor in Psychiatry 

Samuel Novey Instructor in Psychiatry 

Marion W. Mathews Instructor in Psychiatry 

Enoch Callaway, Jr Instructor in Psychiatry 

William N. Fitzpatrick ' Assistant in Psychiatry 

Gertrude Gross Assistant in Psychiatry 

Marcella Weisman Assistant in Psychiatric Social Work 

Vesta May Stevens Assistant in Psychiatric Social Work 

Marjorie R. Fleitzer Assistant in Psychiatric Social Work 

Hermione Hunt Hawkins Assistant in Clinical Psychology 

Marvin Jaefe Fellow in Psychiatry 

Virginia Suttonfield Fellow in Psychiatry 

Ruth Page Edwards Fellow in Psychology 



SCHOOL OF MEDICINE 85 

Jeannette F. Rayner Research Assistant in Psychiatry 

Betty J. Fax Research Assistant in Psychiatry 

John Walker Powell Research Assistant in Psychiatry 

Davtd Willenson Research Assistant in Psychiatry 

Barbara Elizabeth Todd Research Assistant in Psychiatry 

Carolyn Mae Miller Research Assistant in Psychiatry 

First Year. Fourteen two-hour periods during the second semester are devoted 
to a consideration of human relations as applied to the practice of medicine. The 
topics dealt with include personality development, reactions to stress, and situ- 
ational and social factors in disease. The emphasis is upon observing, under- 
standing and evaluating the personal and social factors in the disease process, in 
treatment and prevention. Consideration is given to problems of values and 
scientific methodology as they apply to the work of the physician. Patients with 
common medical and surgical complaints are interviewed to illustrate methods of 
interviewing and developing a useful therapeutic relationship. The course is 
conducted by means of group discussion, supplemented by reading. 

Second Year. Fourteen two-hour periods are spent in the first semester in dis- 
cussions and lectures. The emphasis is on methods of examining patients, and 
methods of developing and utilizing the doctor-patient relationship. The dis- 
cussions center about psychopathology, as it operates in disease and in the treat- 
ment process. An attempt is made to relate emotional disturbances to what is 
known in neurophysiology, endocrinology, psychology and sociology. Patients 
are interviewed and examined to illustrate the general principles and the specific 
procedures used in the examination of patients. The group discussions are supple- 
mented by suggested reading. 

Third Year. Sixteen lecture hours are devoted to further considerations of 
special psychopathology and the principles of psychotherapy. Specialized forms 
of treatment are reviewed, but the main emphasis is toward familiarizing the 
student with forms of therapy feasible in routine medical practice. During 36 
clinic hours the student will be supervised in history-taking, mental status and 
psychometric examination, and follow-up studies of patients. 

Fourth Year. A clinical clerkship is offered in the wards of the University 
Hospital for one month. Patients are assigned for treatment under supervision. 
Emphasis is placed on diagnosis, methods of interviewing, methods of developing 
and managing a therapeutic doctor-patient relationship, and carrying out psycho- 
therapy. This is supplemented by seminar meetings for discussion of child psy- 
chiatry, psychotherapy, clinical psychology and social service. Topics are assigned 
from the current literature for group discussion. Four afternoons are spent in 
the wards of the Spring Grove State Mental Hospital in examining patients with 
emphasis in the diagnosis, treatment and management of the psychoses. Eight 
clinics are held for the entire fourth-year class. 

ROENTGENOLOGY 

Walter L. Ktlby Professor of Roentgenology, and Head of the Department 

Charles N. Davidson Associate Professor of Roentgenology 

John DeCarlo, Jr Assistant Professor of Roentgenology 



86 UNIVERSITY OF MARYLAND 

Donald J. Barnett Assistant Professor of Roentgenology 

Edward R. Dana Associate in Roentgenology 

John T. Brackin Instructor in Roentgenology 

John M. Dennis Instructor in Roentgenology 

Eugene R. McNlnch Fellow in Roentgenology 

Robert VV. Swain Consultant in Radiologic Physics 

During the academic year, small groups of the third and fourth year classes are 
given weekly instruction in the diagnostic and therapeutic uses of the Roentgen 
rays. An effort is made to familiarize the student with the indications for and the 
limitations of the Roentgen ray examinations. The history, physics and practical 
therapeutic application of Roentgen rays are given stressing the use of radiation 
as a weapon now available in a variety of disorders of the human body ranging from 
simple inflammations to malignant neoplastic conditions. Conferences are held 
with the various departments during the school year which are also open to mem- 
bers of the fourth year class. 

Third year 8 hours 

Fourth year 24 hours 

Total 32 hours 

SPEECH TRAINING CLINIC [a division of surgery] 

Edward A. Kitlowski Clinical Professor of Plastic Surgery 

Ray Ehrensberger Professor of Speech 

Merle Ansberry Associate Professor of Speech 

This department has been installed in conjunction with the Department of 
Speech of the University at College Park to evaluate the speech difficulties in 
children with congenital defects. Admission to the Clinic is by appointment only. 
The Clinic operates all day Thursdays. 

SURGERY 

Charles Reid Edwards Professor of Surgery, and Acting Head of the Department 

Walter D. Wise Professor of Surgery 

Elliott H. Hutchtns Professor of Surgery 

D. J. Pessagno Professor of Clinical Surgery 

F. L. Jennings Professor of Clinical Surgery 

George H. Yeager Professor of Clinical Surgery 

Monte Edwards Clinical Professor of Surgery 

Otto C. Brantigan Professor of Clinical Surgery 

Harry C. Hull Professor of Clinical Surgery 

James W. Nelson, M.D Professor of Clinical Surgery 

R. Rkgeway Trimble Professor of Clinical Surgery 

Charles A. Reifschneider Clinical Professor of Traumatic Surgery 

Thomas R. Chambers Associate Professor of Surgery 

R. W. Locher Associate Professor of Clinical Surgery 

Edward S. Johnson Associate Professor of Surgery 

Grant E. Ward Associate Professor of Surgery 

Cyrus F. Hortne Associate Professor of Surgery 

Charles W. Maxson Associate Professor of Surgery 



SCHOOL OF MEDICINE 87 

C. W. Peake Associate Professor of Surgery 

William F. Reinhoff, Jr Associate Professor of Surgery 

W. Wallace Walker Associate Professor of Surgery and Surgical Anatomy 

H. F. Bongardt Assistant Professor of Surgery 

I. O. Ridgely Assistant Professor of Surgery 

Arthur G. Siwtnski Assistant Professor of Surgery 

Simon H. Brager Assistant Professor of Surgery and Proctology 

Thurston R. Adams Assistant Professor of Surgery 

Raymond F. Helfrich Associate in Surgery 

William B. Settle Associate in Surgery 

George Govatos Associate in Surgery 

Joseph V. Jerardi Associate in Surgery 

Herbert E. Relfschneider Associate in Surgery 

Harold H. Burns Associate in Surgery 

William L. Garlick Associate in Surgery 

Harry C. Bowie Associate in Surgery 

Edward H. Stewart Associate in Surgery 

Joseph M. Miller Lecturer in Surgery 

J. Duer Moores Instructor in Surgery 

Calvin Hyman Instructor in Surgery 

Clyde F. Karns Instructor in Surgery 

Daniel R. Robinson Instructor in Surgery 

George H. Brouillet Instructor in Surgery 

John F. Schaefer Instructor in Surgery 

Robert F. Healy Instructor in Surgery 

Robert C. Sheppard Instructor in Surgery 

Samuel E. Proctor Instructor in Surgery 

F. Ford Loker Instructor in Surgery 

E. Roderick Shipley Instructor in Surgery 

Patrick C. Phelan, Jr Instructor in Surgery 

Louis E. Goodman Instructor in Surgery 

William R. Geraghty Assistant in Surgery 

Howard B. McElwain Assistant in Surgery 

A. V. Buchness Assistant in Surgery 

T. J. Touhey Assistant in Surgery 

Samuel H. Culver Assistant in Surgery 

L. T. Chance Assistant in Surgery 

W. Allen Deckert Assistant in Surgery 

William C. Dunnigan Assistant in Surgery 

Howard L. Zupnik Assistant in Surgery 

Raymond M. Cunningham Assistant in Surgery 

John W. Chambers Assistant in Surgery 

Ross Z. Plerpont Assistant in Surgery 

Michael L. DeVincentis Assistant in Surgery 

James N. Cianos Assistant in Surgery 

Richard M. Garrett Assistant in Surgery 

William D. Lynn Assistant in Surgery 

R. Adam Cowley. . .Assistant in Thoracic Surgery; Assistant Director Surgical Research 

Davtd R. Will Assistant in Surgery 

Harold P. Blehl Assistant in Surgery 



88 UNIVERSITY OF MARYLAND 

Instruction is given by means of lectures, laboratory work, recitations, dis- 
pensary work, bedside instruction, ward classes, and clinics. The work begins 
in the second year and continues throughout the third and fourth years. 

The teaching is done in the anatomical laboratory, operative surgery labora- 
tory, the dispensaries, wards, laboratories and operating rooms of the University 
and Mercy Hospitals, and in the wards and operating rooms of the Baltimore City 
Hospitals. 

SECOND YEAR 

Topographic and Surgical Anatomy. Second semester. The course is 
designed to bridge the gap between anatomy in the abstract and clinical anatomy 
applied to the study and practice of medicine and surgery. 

The teaching is done in the anatomical laboratory. Students are required to 
dissect and to demonstrate all points, outlines, and regions on the cadaver. Under- 
lying regions are dissected to bring out outlines and relations of structures. 

Two lectures and two laboratory periods per week. Drs. Brantigan, Walker, 
Settle, Bowie, H. E. Reif Schneider, Pierpont and Garrett. 

Total hours: 96. 

Principles of Surgery. Second semester. The course includes discussions 
of irritants, infection, repair of tissue, healing of tissue, relationship of bacteriology 
to surgery, modern chemotherapy in surgical diseases, ulcers, wounds, thrombo- 
phlebitis, phlebothrombosis, peripheral vascular diseases, thermal burns, injuries 
due to cold, surgical shock, diseases of the lymphatics, gangrene of the skin and 
extremities, aneurysms, hemorrhage, varicose veins, embolism, sinuses and fistulae, 
tetanus, anthrax and actinomycosis. 

Lectures, two hours a week for one semester, are given to the whole class. Drs. 
Adams and Sheppard. 

THIRD YEAR 

General and Regional Surgery. Lectures, recitations and clinics on the 
principles of surgery, general surgery including fractures and dislocations are 
given three hours a week to the whole class. Dr. Hull. 

The class is divided into groups and receives instruction in history-taking 
and surgical pathology under the supervision of the chief of the pathology 
department of the Baltimore City Hospitals. Instruction is also given in surgi- 
cal diagnosis and in general surgery at the bedside and in the classroom at this in- 
stitution by Drs. Bowie, Koontz, Brantigan and Adams. Two hours per week 
are given in orthopaedic surgery by Dr. Voshell, chief of the orthopaedic service 
of this institution. 

Operative Surgery. Lectures and operative demonstrations are given under 
the supervision of Dr. Yeager assisted by Dr. Govatos. The class is divided into 
sections and each section is given practical and individual work under the super- 
vision of instructors. 

Surgical Out-patient Department. Under supervision, the student takes 
the history, makes the physical examination, attempts the diagnosis and, as far 
as possible, carries out the treatment of ambulatory surgical patients in the 
University and Mercy Hospitals. Mercy Hospital — Dr. Raymond F. Helfrich 



SCHOOL OF MEDICINE 89 

assisted by the out-patient staff. University Hospital — Drs. Settle and Sheppard 
assisted by the out-patient staff. 

FOURTH YEAR 

Clinics. Surgical pathological Conference. A weekly conference is conducted 
at the University Hospital for the entire class. Daily ward classes at University 
and Mercy Hospitals, and half day ward work under the supervision of Dr. E. R. 
Shipley at University and Dr. F. Ford Loker, Mercy Hospital. 

Surgery or the Chest: — Mercy Hospital. Operations and conferences. 14 
hours. Drs. Rienhoff and Garlick. 

Traumatic Surgery. This course deals with operative and post-operative 
treatment of accident cases and with instructions as to the relationship between the 
state, the employee, the employer, and the physician's duty to each. One hour 
a week to sections of the class throughout the year. Dr. C A. Reifschneider. 

Clinical Clerkship. This work includes the personal study of assigned 
hospital patients under supervision of the staffs of the University and Mercy 
Hospitals, and embraces history-taking, and physical examination of patients, 
laboratory examinations, attendance at operations and observation of post- 
operative treatment. 

Ward Classes. Ward-class instruction in small groups will consist of ward 
rounds, surgical diagnosis, treatment and the after-care of operative cases. Mercy 
Hospital — Drs. Wise, Hutchins, Pessagno, Nelson, Trimble, Brager, Jerardi, Gar- 
lick and Loker. University Hospital — Drs. C. Reid Edwards, Yeager, Hull and 
C. A. Reifschneider. 

THORACIC SURGERY [a division of surgery] 

Otto C. Brantigan Professor of Thoracic Surgery 

William L. Garlick Associate Professor of Thoracic Surgery 

Donald B. Hebb Assistant in Thoracic Surgery 

R. Adams Cowley Assistant in Thoracic Surgery 

Sim Penton Resident in Thoracic Surgery 

Frank Faraino Fellow in Thoracic Surgery 

Men having completed three years of American Board of Surgery training are 
eligible for appointment. The first year is spent in thoracic research surgery. The 
second year is in clinical thoracic surgery at Baltimore City, Mercy and Univer- 
sity Hospitals. 

TROPICAL MEDICINE [a division of medicine! 

Certain phases of tropical medicine are considered in the course on clinical 
pathology. In addition, a course of lectures and demonstrations is given to the 
entire fourth year class. 

TUBERCULOSIS [a division of medicine] 

During the third year in connection with the instruction in physical diagnosis 
a practical course is given at the Municipal Tuberculosis Hospital. Stress is laid 
upon the recognition of the physical signs of the disease, as well as upon its sympto- 
matology and gross pathology. 



90 UNIVERSITY OF MARYLAND 

UROLOGY [a division of surgery] 

W. Houston Toulson Professor of Urology 

Kenneth D. Legge Professor of Clinical Urology 

Howard B. Mays Assistant Professor of Urology 

Francis W. Gillis Assistant Professor of Urology 

John F. Hogan Assistant Professor of Urology 

Austin H. Wood Associate in Urology 

Lyle J. Millan Associate in Urology 

L. K. Fargo Associate in Urology 

Hugh J. Jewett Associate in Urology 

John S. Haines Associate in Urology 

Martin A. Robbins Instructor in Urology 

John D. Young, Jr Instructor in Urology 

Charles W. Hawkins Assistant in Urology 

Morris A. Fine Assistant in Urology 

Henry K. Jarrett Assistant in Urology 

Third Year. This course is given for seven hours to the whole class. It con- 
sists of lectures and demonstrations, including the use of lantern slides and motion 
pictures. Dr. Toulson. 

Fourth Year. The course includes explanations and demonstrations of urethros- 
copy, cystoscopy, ureteral catheterization, renal function tests, urography, urine 
cultures and the various laboratory procedures. The teaching consists of clinics 
and ward rounds to small groups, and attendance by members of the senior class 
upon the out-patients in the dispensary. The student is placed on his own re- 
sponsibility in arriving at a diagnosis. These dispensary classes are conducted 
at both the Mercy and University Hospitals where practically every variety of uro- 
genital disease is seen and used for teaching purposes. 

Third year 6 hours 

Fourth year 39 hours 

Total 45 hours 

MEDICAL LIBRARY 

Howard Rovelstad, A.B., M.A., B.S.L.S Director of Libraries and Professor 

of Library Science 



Ida Marian Robinson, A.B., B.S.L.S Librarian and Associate Professor of 

Library Science 

Hilda E. Moore, A.B., A.B.L.S Assistant Librarian 

Florence R. Klrk Assistant Librarian 

Marie Harvin, B.A., B.S.L.S Cataloguer 

Charlotte Wilson Assistant to the Cataloguer 

Jane Spacek Secretary to the Librarian 

POSTGRADUATE COURSES 
Committee on Postgraduate Studies 
Howard M. Bubert, Chairman and Director 



SCHOOL OF MEDICINE 91 

Dietrich C. Smith, 1st Vice-chairman Frank H. J. Figge 

L. A. M. Krause, 2nd Vice-chairman Wetherbee Fort 

Milton S. Sacks, Secretary John C. Krantz, Jr. 

J. Edmund Bradley J. Morris Reese 

Otto C. Brantigan Allen F. Voshell 

John A. Wagner 

Elizabeth Carroll, Executive Secretary 

The Dean — Ex Officio 

Calendar: Postgraduate courses are offered throughout the year. 

During the past year, the Post Graduate Committee has given an extramural 
course in Hagerstown. Enrollment was 25. The Committee will consider the 
request of any Maryland County Medical Society for a series of lectures to begin 
in the Fall of 1951. 

A sub-committee appointed to survey the hospitals in the State which desire 
assistance in the training of house staffs has been working actively during the year, 
and progress has been made. 

The Basic Science course in OB-GYN has been withdrawn temporarily. 

The following intramural postgraduate courses have been continued. 

General Anatomy: The course is designed to prepare candidates for the ex- 
amination of the American Board of General Surgery and Surgical Specialties. 
There is no strict rule governing either the content or duration of the course. 
Students may dissect a complete cadaver or any particular region in which they 
may be interested. Tuition arranged according to course content and duration. 

Anatomy of Head and Neck as applied to the eye, ear, nose and throat. 
Duration 150 hours, beginning on October 1 and ending approximately February 
28, comprising two periods of 4 hours per week. Tuition $75.00. Details as 
to the time of the individual periods will be arranged with candidates who wish to 
take the course. 

Surgical Anatomy: The course is designed to prepare candidates for the ex- 
amination in Anatomy of the American Board of Surgery. This is a ninety-hour 
course (3 hours a day, 2 days a week) given in conjunction with the regular sopho- 
more medical course in surgical anatomy. Tuition $150.00. 

Pathology: This course is designed to prepare candidates for certification in 
surgery, surgical specialties and internal medicine. Individuals will receive train- 
ing in autopsy and surgical pathology. Minimum duration is full time, six months. 
Tuition $150.00. 

Neuro-pathology: This course is designed to aid in meeting the requirements of 
the specialty boards in neurological sciences and covers basic studies in diseases 
of the central nervous system. Duration is six months, full time. Tuition 
$200.00 plus $10.00 laboratory fee. 

Gynecology and Obstetrics: This is a review for general practitioners. 
Students attend lectures, ward rounds and clinics, and observe operations and 
deliveries. Full time for twelve weeks. Tuition $150.00. 



92 



UNIVERSITY OF MARYLAND 



Gynecology, Oncology and Female Urology: This is a review designed 
primarily for the general practitioner. Students attend lectures, ward rounds 
and clinics and observe operations. Full time for ten weeks. Tuition $125.00. 

Basic Sciences as They Apply to the Practice of Medicine. This course 
is designed to familiarize students with the advances in basic sciences during recent 
years. The course consists of 32 periods of 2 hours each, once a week between 
October and June. Tuition $50.00. 

Full descriptions of these courses are available. Inquiries should be addressed 
to the Post Graduate Committee, University of Maryland School of Medicine, 
Baltimore 1, Maryland. 

LECTURERS IN POSTGRADUATE MEDICINE 



Thurston R. Adams 
Marie A. Andersch 
James G. Arnold, Jr. 
Robert E. Bauer 
Joseph G. Bird 
Harry C. Bowie 
J. Edmund Bradley 
Otto C. Brantigan 
George H. Brouillet 
Howard M. Bubert 
T. Nelson Carey 

C. Jelleff Carr 
Robert Chenowith 
Ernest I. Cornbrooks, Jr. 
Edward F. Cotter 
Richard J. Cross, Jr. 
Francis G. Dickey 
William K. Diehl 
Everett S. Diggs 

D. McClelland Dixon 
Louis H. Douglass 
John C. Dumler 

J. Sheldon Eastland 
Charles Reid Edwards 
William L. Fearing 
Frank H. J. Figge 
Jacob E. Finesinger 
A. H. Finkelstein 



Russel S. Fisher 
Albert E. Goldstein 
Lewis P. Gundry 
Frank W. Hachtel 
Jerome Hartz 
Charles W. Hawkins 
Nathan B. Herman 
Harry C. Hull 
J. Mason Hundley, Jr. 
D. Frank Kaltreider 
Theodore Kardash 
Vernon E. Krahl 
John C. Krantz, Jr. 
L. A. M. Krause 
Arnold F. Lavenstein 
C. Edward Leach 
Ephraim T. Lisansky 
William S. Love, Jr. 
Wm. V. Lovitt, Jr. 
Fred R. McCrumb 
Hugh B. McNally 
Howard B. Mays 
Samuel Morrison 
H. Whitman Newell 
Frank J. Otenasek 
Robert T. Parker 
Ross Z. Pierpont 
Maurice C. Pincoffs 



J. Morris Reese 
Herbert E. Reifschneider 
Dexter L. Reimann 
Henry L. Rigdon 
Harry M. Robinson, Sr. 
Raymond C. V. Robinson 
Milton S. Sacks 
John E. Savage 
Sidney Scherlis 
Emil G. Schmidt 
William B. Settle 
Dietrich C. Smith 
Hugh R. Spencer 
Melchijah Spragins 
Edwin H. Stewart, Jr. 
Harry A. Teitelbaum 
W. Houston Toulson 
Eduard Uhlenhuth 
Henry F. Ullrich 
Allen Fiske Voshell 
John A. Wagner 
Wallace Walker 
Milton J. Wilder 
Walter D. Wise 
Henry L. Wollenweber 
Theodore E. Woodward 
Robert B. Wright 
George H. Yeager 



FIRST YEAR SCHEDULE 
FIRST SEMESTER, SEPTEMBER 20, 1951 TO JANUARY 26, 1952 



Hours 



9.00 

to 
12.00 



12.00 
to 
1.00 

1.00 

to 

5.00 



Monday 



Tuesday 



•Histology and 

Embryology 

Lecture and Lab. 

2nd Floor Bressler 



Wednesday 



Orientation 

9:00-10:00 

1st 3 Lectures 

A.H. 

Anatomy 

10:00-12:00 

1st 3 Sessions 

After Oct. 10 

Anatomy 

9:00-12:00 

lsl Floor Br. Lab. 



Thursday 



Friday 



•Histology and 

Embryology 

Lecture and Lab. 

2nd Flout Bressler 



Lunch 



Gross Anatomy 
Lectures A. E. (1-2) Daily and Laboratories Bressler 1 (2-5) Daily 



Saturday 



Gross Anatomy 
A.E. 



' Course ends December 21, 1951. 

SECOND SEMESTER, JANUARY 28 TO JUNE 7, 1952 



Hours 


Monday 


Tuesday 


Wednesday 


Thursday 


Friday 


Saturday 


9.00 

to 

12.00 


Laboratory 

Biol. Chem. 
Sect. A 


Laboratory 

Biol. Chem. 
Sect. B 


Laboratory 

Biol. Chem. 
Sect. A 


Laboratory 

Biol. Chem. 
Sect. B 






12.00 
to 
1.00 


Lunch 


Lunch 


Lunch 


Lunch 


Lunch 




1.00 

to 

2.00 


Biol. Chem. 
Aim. 1 


Biol. Chem. 
Aim. 1 


Biol. Chem. 

A dm. 1 


Biol. Chem. 
Adm. 1 


Biol. Chem. 
Adm. 1 




2.00 

to 

3.00 


Psychiatry 

2-4 

Amp. 

Univ. Hosp. 


Neuro- 
Anatomy 
Lecture 

and 

Laboratory 

Bressler 
2nd Floor 


Biol. Chem. 

Conference 

Adm. 1 


Neuro- 
Anatomy 
Lecture 

and 

Laboratory 

Bressler 

2nd Floor 


Biol. Chem. 

Conference 

Adm.l 




3.00 

to 

5.00 


Neuro- 
physiology 

4-5 

Bressler 2 




Neuro- 
physiology 
Bressler 2 
(3-4) 





Locations of Lecture Halls and Laboratories: 
Adm. 1— First Floor, Administration Building, 520 W. Lombard Street. 
A. H.— Anatomical Hall— Upper Hall, N. E. Cor. Lombard and Greene Streets. 
C. H.— Chemical Hall, Lower Hall, 522 W. Lombard Street. 
Biological Chemistry Laboratory— Third Floor, 31 South Greene Street. 
Bressler Research Laboratory— 29 S. Greene Street. 
Gross Anatomy— First Floor. 
Histology and Embryology— Second Floor. 
Neuro-anatomy— Second Floor . 

Mid-Year Examinations— January 21-26, 1952 
Final Examinations— Begin May 26, 1952 

93 



SECOND YEAR SCHEDULE 
FIRST SEMESTER, SEPTEMBER 20, 1951 TO JANUARY 26, 1952 



Hours 


Monday 


Tuesday 


Wednesday 


Thursday 


Friday 


Saturday 


8.30 
9.30 


Physiology 
Bressler 2 


Physiology 
Bressler 2 


Medicine 
Bressler Z 


Physiology 
Bressler 2 


Physiology 
Bressler Z 




9.30 

to 
10.30 


Physiology 
Conference 
Bressler 2 


Bacteriology 
Aim. 1 


Bacteriology 
Adm. 1 


Pharmacology 
Bressler Z 


Pharmacology 
Bressler Z 




10.30 

to 
12.30 


tBacteriology 
Laboratory 


Neurological 

Diagnosis 

10:45-11:45 

C.H. 




12.30 


Lunch 




1.00 


Pharmacology Lecture 

Bressler 2 

Sect. B. | Sect. A. 

1:00-2:00 


Psychiatry 

1:30-3:30 

C.H. 


Pharmacology Laboratory 

3rd Floor Bressler 

Sect. B. | Sect. A. 

1:00-4:00 




to 
5.00 


Physiology Laboratory 

4th Floor Bressler 

Seel. A. | Sect. B. 

1:00-5:00 


Physiology Laboratory 

4th Floor Bressler 

Sect. A. | Sect. B. 

1:00-5:00 





t Bacteriology Laboratory — Section work during the last month. 

SECOND SEMESTER, JANUARY 28 TO JUNE 7, 1952 



Hours 


Monday 


Tuesday 


Wednesday 


Thursday 


Friday 


Saturday 


8.30 

to 
9.30 


Surgery 
Bressler Z 


Surgery 
Bressler Z 


Surgical 
Anatomy 
Adm. 1 


Medical Clinic 

Amp. 

Dispensary 

Building 


Physical 
Diagnosis 

Adm. 1 


Orthopaedics 
Bressler 2 


9.30 
to 

10.30 


Pharmacology 
Bressler Z 


Pharmacology 
Bressler Z 


Surgical 
Anatomy 
Laboratory 

Bressler 1 


Pharmacology 
Bressler 2 


Obstetrics 
Bressler Z 


10.30 

to 
11.30 


Pathology 
C. H. 


Pathology 
C.H. 


Pathology 
Adm. 1 


Pathology 
C.H. 




11.30 


Lunch 




12.00 

to 
2.00 


Pathology 
Laboratory 


Pathology 
Laboratory 


Immunology 
Laboratory 


Pathology 
Laboratory 


Pathology 
Laboratory 




2.00 

to 
3.00 


Surgical 

Anatomy 

Adm. 1 


!! Immunology 
Laboratory 


Pharmacology 

Laboratory 

Sect. A 

Physical 

Diagnosis 

Sect. B 

(3:00-5:00) 

U.H.D. 


Pharmacology 

Laboratory 

Sect. B 

Physical 

Diagnosis 

Sect. A 

(3:00-5:00) 

U.H.D. 




3.00 

to 
5.00 


Surgical 
Anatomy 
Laboratory 
Bressler I 


Optional period 
Pathology 

Immunology 





|j Immunology Laboratory — Section work during last two months. 

Locations of Lecture Halls and Laboratories: 
Adm. 1— First Floor, Administration Building, 520 W. Lombard Street. 
C. H.— Chemical Hall, Lower Hall, 522 W. Lombard Street. 

Amp.— Wilson Memorial Amphitheatre, New University Hospital, Greene and Redwood Streets, Eighth Floor. 
U. H. D.— University Hospital Dispensary, Old Hospital Building. 
Laboratories: 

Physiology, Pharmacology, Surgical Anatomy— Bressler Building. 
Bacteriology, Immunology, Pathology, Second Floor, 31 S. Greene Street. 
Mid-Year Examinations — January 21-26, 1952 
Final Examinations— Begin May 26, 1952 

94 



SCHOOL OF MEDICINE 



95 



THIRD YEAR SCHEDULE 
SEPTEMBER 20, 1951 TO JUNE 7, 1952 



SCHEDULE 1 



Hoars 


Monday 


Tuesday 


Wednesday 


Thursday 


Friday 


Saturday 




(Whole Class) 


(Whole Class) 


(Whole Class) 


(Whole Class) 


(Whole Class) 


(Whole Class) 


1.30 
to 


Obstetrics 


Surgery 


Obstetrics 


Surgery 


Pathology 


Surgery 


C.H. 


C.H. 


C.H. 


C.H. 


C.H. 


C.H. 


tGynecology 




tGynecology 






t Anaes thesiology 




March 31 to 




Mar. 26 to 






Mar. IS to May 17 




May 12 




May 14 






Amp. 


9.30 














to 




Transfer to Baltimore City Hospitals 






10.00 














10.00 

to 
12.00 




Physical Diagnos 


is, Pathology, Pediatrics and Neurology at B. C. H. 








(See Group Schedules) 






12.00 


Transfer 


Transfer 




Transfer 






to 


and 


and 


Lunch 


and 


Lunch 




1.00 


Lunch 


Lunch 




Lunch 










(Whole Class) 












•Gynecology 




(Whole Class) 








(Whole Class) 


tEye— 10 wks. 


Medical 










Nose & Throat, 


Jan. 29 to 




Clinical 


Obstetrics 




1.00 


Urology , 


Apr. 1 










to 


Otology, 


tOncology 


Clinic 


Pathology 






2.00 


Proctology, 

Plastic Surgery 

C.H. 


— 5 wks. 

Apr. 8 to 

May 6 














C.H. 


B. C. H. 


Bressler Z 


B. C. H. 














Surgery 












(Whole Class) 


(2-3) 
B. C. B. 




2.00 


(Whole 


Class) 










Pathology '. 
3 




Surgery 


Clinical 




4.00 


t 


Orthopaedics 












Pathology 


(3-4) 
B. C. B. 






(Whole Class) 










4.00 


J Legal Medicine 


(Whole Class) 
Hygiene and 
Public Health 


Orthopaedics 


Laboratory 


Neuro-Surgery 




to 


§ Industrial 


Roentgenology 








5.00 


Medicine 

II Psychiatry 

C.H. 


C.H. 


B. C. H. 


Bressler 5 


B. C. B. 





First Semester. t Second Semester. % Sept. 24 to Dec. 10. § Dec. 17 to Feb. 11. || Feb. 18 to May 12 



SCHEDULE 2 



Hoars 


Monday 


Tuesday 


Wednesday 


Thursday 


Friday 


Saturday 




(Whole Class) 


(Whole Class) 


(Whole Class) 


(Whole Class) 


(Whole Class) 


(Whole Class) 


8.30 


Obstetrics 


Surgery 


Obstetrics 


Surgery 


Pathology 


Surgery 


C.H. 


C.H. 


C.H. 


C.H. 


C.H. 


CH. 


9.20 


tGyn ecology 

March 31 to 

May 12 




tGyn ecology 

Mar. 26 to 

May 14 






Anaesthesiology 

Mar. 15toMayl7 

Amp. 


9.30 




Medicine 


Medicine 


Therapeutics 


Medicine 




to 


C.H. 


t Pediatrics 


t Pediatrics 


t Pediatrics 


t Pediatrics 


Neurology 


10.20 




C.H. 


C.H. 


C. H. 


C.H. 


C. H. 


10.30 




Operative Surgery — Bressler 6 






to 
12.30 




Medical and Surgical Dispensaries 


— (Univ. and Mercy Sections) 




12.30 












to 




Lunch 








1.00 












1.00 






Medical 








2.00 






Clinic 










Sam 


: as 


Amp. 


Same as 


Psychiatry 
Dermatology 




2.00 


Ophthalmoscopy 
*• (S weeks) 




to 


Sche< 


ule 1 


B. E. H. 


Schedule 1 


U. H. Disp 
1-4 




4.00 






Obstetrics 
*» (5 weeks) 
U. H. Disp. 

Otology 
** (5 weeks) 








4.00 








Obstetrics 




5.00 






Univ. Hosp. 
3-C 




C. H. 





The Junior Class will be divided into two sections — A and B. Each section reports to classes in keeping with the 
following schedule assignment, in which the letters represent the class sections and the numerals indicate the schedules to 
be followed for the periods shown. 

J Pediatrics given the last week in each semester. 



Schedule Assignment 
Semester Periods: 

September 20, 1951 to January 26, 1952 

January 28 to May 17, 1952 

•* 5-week periods: 

First Semester Second Semester 

Sept. 20-OcL 24 Jan. 28-Mar. 4 

Oct 25-Dec. 4 Mar. 5-Apr. 8 

Dec. 5-Jan. 19 Apr. 9-May 17 

Locations of Lecture Halls, etc. 
A dm. 1. — First Floor, Administration Building, 520 W. Lombard Street. 

A. H— Anatomical Hall, Upper Hall, 522 W. Lombard Street. 

Amp. — Wilson Memorial Amphitheatre, New University Hospital, Eighth Floor. 

B. C. H— Baltimore City Hosps., 4940 Eastern Ave. 

B. E. H— Baltimore Eye, Ear and Throat Hospital, 1214 Eutaw Place. 
Bressler — Bressler Building, 29 S. Greene Street. 

C. H.— Chemical Hall, Lower Hall, 522 W. Lombard Street. 

Univ. Hosp. — New University Hospital, Greene and Redwood Streets. 
U. H. Disp. — Old Hospital Building, S. W. Cor. Lombard and Greene Streets. 
31 — 31 South Greene Street. 

Clinical Pathology Laboratory — Fifth Floor, Bressler Building. 
Pathology Laboratory— 31 South Greene Street, Special Rooms, Basement. 
Mid-Year Examinations — January 21-26, 1952 
Final Examinations — Begin May 19, 1952 

96 



Sections and Schedules 

A-l, B-2 

B-l, A-2 



SCHOOL OF MEDICINE 



97 



FOURTH YEAR SCHEDULE 
SEPTEMBER 20, 1951 TO MAY 24, 1952 

CLASS DIVISIONS* 



Division If 


Division 2 


Division 3f 


Division 4 


Medicine and Medical 


Pediatrics 


Surgery and Surgical 


Obstetrics 


Specialties (8 weeks) 


(4 weeks) 


Specialties (8 weeks) 


(2 weeks) 


Neurology 


Psychiatry 


Urology 


Gynecology 


Cardiology 


(4 weeks) 


Neuro Surgery 


Oncology 


Gastro-Enterology 




Otology, Rhinology and 


(2 weeks) 


Metabolism 




Laryngology 


— 


Allergy 




Orthopaedics 


Dermatology & Syphilology 


— 




— 


Oncology 


Roentgenology 




Roentgenology 


Ophthalmology 
Anesthesiology 

(4 weeks) 



STUDENT GROUP ASSIGNMENTS 



1st Quarter 


3rd Quarter 


Sept. 20, 1951 to Nov. 15, 1951 
(8 weeks) 

Groups 1, 2, 3, 4 to Division If 
Groups 5, 6, 7, 8 to Division 2 
Groups 9, 10, 11, 12 to Division 3f 
Groups 13, 14, 15, 16 to Division 4 


Jan. 28, 1952 to March 26, 1952 
(8 weeks) 

Groups 1, 2, 3, 4 to Division 3f 
Groups 5, 6, 7, 8 to Division 4 
Groups 9, 10, 11, 12 to Division It 
Groups 13, 14, 15, 16, to Division 2 


2nd Quarter 


4th Quarter 


Nov. 16, 1951 to Jan. 26, 1952 
(8 weeks) 

Groups 1, 2, 3, 4 to Division 2 
Groups 5, 6, 7, 8 to Division 3f 
Groups 9, 10, 11, 12 to Division 4 
Groups 13, 14, 15, 16 to Division It 


March 27, 1952 to May 24, 1952 
(8 weeks) 

Groups 1, 2, 3, 4 to Division 4 
Groups 5, 6, 7, 8 to Division It 
Groups 9, 10, 11, 12 to Division 2 
Groups 13, 14, 15, 16 to Division 3t 



•The curriculum is arranged into 4 divisions, and the senior class into 16 groups. 

t The curriculum of Divisions 1 and 3 is given at the University and Mercy Hospitals simultaneously. There are 
4 groups assigned to each division. Two groups or one half the students of each division are assigned work for 4 
weeks at each hospital. Students belonging to groups 1, 2, 9 and 10 report to the University Hospital for the 1st 4 
weeks. Groups 3, 4, 11 and 12 report to Mercy. At the end of 4 weeks the students at the University Hospital re- 
port to Mercy and the groups at Mercy report to the University Hospital for a similar period, thus completing for each 
group involved one division of work. 



98 



UNIVERSITY OF MARYLAND 



UNIVERSITY OF MARYLAND SCHOOL OF MEDICINE 
AND COLLEGE OF PHYSICIANS AND SURGEONS 



GRADUATES, JUNE 9, 1951 



Agee, Law Lamar, B.S Alabama 

Arthur, Robert Key, Jr., B.S. . . Georgia 

Barthel, John Paul Maryland 

Beardsley, Earl Miller Maryland 

Bell, Arthur Keith, B.A Maryland 

Bilder, Joseph, Jr., B.S Ohio 

BrRELY, Beverly Robert Maryland 

Blades, Nancy, B.A New Jersey 

Bossard, John Wesley, B.A. . Maryland 
Brannon, John Vandale, B.S. 

West Virginia 

Buell, John Russell, Jr Maryland 

Christopher, Russell Lee, B.A. 

Massachusetts 
Clemmens, Raymond Leopold, B.S. 

Maryland 
Coffman, Kaohlin Miner, B.A. 

Pennsylvania 

Cohen, Solomon, B.A Maryland 

Curanzy, Raymond Ralph, B.S. 

Pennsylvania 

Deckelbaum, Joseph, B.S Maryland 

Dettbarn, Ernest Albert, B.S. 

Maryland 

Donner, Leon, B.S Maryland 

Dudley, Winston Clark, B.A. 

Massachusetts 
Dunn, George Mitchell, Jr. 

Washington, D. C. 
Dunnagan, William Andrew, B.A. 

North Carolina 
Edwards, David Everett . Pennsylvania 
Edwards, William Hunter, Jr., B.A. 

Maryland 
Esmond, William George, B.S. . Maryland 
Evans, Otis Druell, Jr., B.S. 

North Carolina 
Ferguson, Charles Kirkpatrick 

Colorado 
Fitzgerald, Joseph Carroll, B.A. 

Maryland 
Fullilove, Rowland Elder Jack 

Georgia 
Gallagher, James Patrick, B.A. 

West Virginia 
Garcia Palmteri, Mario Ruben, B.S. 

Puerto Rico 
Gardner, Francis Sdoney, Jr., B.A. 

North Carolina 

Gates, John Butler Wisconsin 

Gordon, Benjamin Dichter, B.A. 

New York 
Hatem, Frederick Joseph, B.S. 

Maryland 
Hopkins, Robert Charles, B.S. 

Pennsylvania 
Iten, George Joseph, B.A California 



Johnson, Frederick Miller, B.S., M.S. 

Maryland 
Johnson, Wallace Edward 

New Hampshire 
Kaschel, Paul Edward, B.A. . New Jersey 

Kindt, Willard Freed Pennsylvania 

KrNG, Victor Francis Maryland 

Ktpnis, Davdd Morris, B.A., M.A. 

Maryland 

Knd?p, Harry Lester Maryland 

Kramer, Howard Calvin Maryland 

Lamb, William Eugene, B.S Florida 

Lanntng, Theodore Reuney, B.S. 

New Jersey 

Leibman, Jack, B.A Maryland 

Ley, Leo Henry, Jr Maryland 

Lister, Leonard Melvin Maryland 

MacDonald, James Melvin, Jr., B.S. 

Maryland 
McFadden, Earl Boyd, B.S. . . . Maryland 
McFadden, John William, B.S. 

Maryland 
McGrady, Charles Winfred, Jr., B.S. 

Georgia 
McGrady, Kathleen Reilly, B.S. 

New York 
Mendez Bryan, Ricardo Tomas, B.S. 

Puerto Rico 
Metcalf, John Shelby, Jr. . . . California 
Mosser, Robert Schaaf, B.S.. .Maryland 

Mutter, Arthur Zelig, B.S Maryland 

Myers, Donald Johnson, B.S Ohio 

Nygren, Edward Joseph, B.A.. Maryland 

Orth, John Stambaugh Maryland 

Packard, Douglas Richards . . Maryland 
Pencheff, Dorris Marie, B.A. . California 
Perilla, Frank Robert, B.S.. .Maryland 
Perry, Henry David, Jr., B.A. . . Florida 
Reeser, Guy McClelland, Jr., B.A. 

Maryland 
Reeves, Henry Gray, Jr. 

North Carolina 

Rex, Eugene Braiden Colorado 

Reynolds, Georgia, B.A Maryland 

Richardson, Aubrey DeVaughn, B.S. 

North Carolina 

Rombro, Marvin Jay, B.A Maryland 

Rowland, Harry Shepard, Jr., B.A. 

New Jersey 
Saavedra Amador, Armando, B.S. 

Puerto Rico 
Schmale, Arthur Henry, Jr.. .Nebraska 

Scott, Roger David Florida 

Scully, John Thorsen Indiana 

Shea, William Harold Holland. B.S. 

Maryland 
Sherry, Samuel Norman, B.S. . Maryland 



SCHOOL OF MEDICINE 99 

Simmons, Leslie Dale, B.S. Venrose, Robert James, B.A Ohio 

West Virginia Watson, Charles Polk, Jr., B.A. 

Sipple, Edward M., B.A Maryland West Virginia 

Skipton, Roy Kennedy, B.S. ... Maryland Weekley, Robert Dean, B.S Ohio 

Solomon, David Milton Maryland Wheelwright, Harvey Pearse Utah 

Stone, John Hopkins, B.S Maryland Williams, Charles Ray, B.A. 

Sutton, Julian Theoplous B.A. y Shelley c Pennsylvania 

„ North Carolina North Carolina 

Tobias, Richard Boyd, B.S. . Pennsylvania York, Thomas Luther, B.A. 

Twigg, Homer Lee, Jr Maryland North Carolina 

Udel, Melvln, B.A Maryland Young, Calvin Lessey, B.S. . . . Maryland 

HONORS 

University Prize Gold Medal 

David Morris Kd?nis 

Certificate op Honor 

Leonard Melvin Lister Leon Donner 

Frank Robert Perilla Douglas Richards Packard 

William George Esmond 

The Dr. A. Bradley Gaither Memorial Prize 
Leonard Melvin Lister 

The William D. Wolfe Memorial Prize and Certificate of 
Proficiency 

Charles Polk Watson, Jr. 

INTERNSHIPS— GRADUATES OF JUNE 9, 1951 
July 1, 1951-June 30, 1952 

Ager, Law Lamar Jefferson Hillman Hospital, Birmingham, Ala. 

Arthur, Robert Key, Jr Jefferson Hillman Hospital, Birmingham, Ala. 

Barthel, John Paul St. Luke's Methodist Hospital, Cedar Rapids, Iowa 

Beardsley, Earl Miller U. S. Naval Hospital, San Diego, Cal. 

Bell, Arthur Keith The Toledo Hospital, Toledo, Ohio 

Bilder, Joseph, Jr The City Hospital of Akron, Akron, Ohio 

Birley, Beverly Robert Union Memorial Hospital, Baltimore, Maryland 

Blades, Nancy The Christ Hospital, Cincinnati, Ohio 

Bossard, John Wesley University Hospital, Baltimore, Md. 

Brannon, John Vandale U. S. Naval Hospital, San Diego, Cal. 

Buell, John Russell, Jr Mercy Hospital, Baltimore, Md. 

Christopher, Russell Lee Harrisburg Polyclinic Hospital, Harrisburg, Pa. 

Clemmens, Raymond Leopold Mercy Hospital, Baltimore, Md. 

Coffman, Kaohlln Miner The Williamsport Hospital, Williamsport, Pa. 

Cohen, Solomon Sinai Hospital, Baltimore, Md. 

Curanzy, Raymond Ralph Reading Hospital, Reading, Pa. 

Deckelbaum, Joseph Sinai Hospital, Baltimore, Md. 

Dettbarn, Ernest Albert Lutheran Hospital of Maryland, Inc., Baltimore, Md. 

Donner, Leon Sinai Hospital, Baltimore, Md. 



100 UNIVERSITY OF MARYLAND 

Dudley, Winston Clark Baltimore City Hospitals, Baltimore, Md. 

Dunn, George Mitchell, Jr University Hospital, Baltimore, Md. 

Dunnagan, William Andrew U. S. Marine Hospital, Detroit, Mich. 

Edwards, David Everett U. S. Marine Hospital, Norfolk, Va. 

Edwards, William Hunter, Jr Union Memorial Hospital, Baltimore, Md. 

Esmond, William George Lutheran Hospital of Maryland, Inc., Baltimore, Md. 

Evans, Otis Druell, Jr. 

University of Texas Medical Branch Hospitals, Galveston, Texas 

Ferguson, Charles Kirkpatrick Bethesda Hospital, Cincinnati, Ohio 

Fitzgerald, Joseph Carroll University Hospital, Baltimore, Md. 

Fullilove, Rowland Elder Jack Church Home and Hospital, Baltimore, Md. 

Gallaher, James Patrick The Reading Hospital, Reading, Pa. 

Garcia Palmteri, Mario Ruben Fajardo District Hospital, Fajardo, Puerto Rico 

Gardner, Francis Sidney, Jr City of Detroit Receiving Hospital, Detroit, Mich. 

Gates, John Butler Mercy Hospital, San Diego, Cal. 

Gordon, Benjamin Dichter King County Hospital, Brooklyn, N. Y. 

Hatem, Frederick Joseph U. S. Naval Hospital, Staten Island, N. Y. 

Hopkins, Robert Charles St. Vincent's Hospital, Erie, Pa. 

Iten, George Joseph St. Agnus Hospital, Baltimore, Md. 

Johnson, Frederick Miller Baltimore City Hospitals, Baltimore, Md. 

Johnson, Wallace Edward St. Francis Hospital, Hartford, Conn. 

Kaschel, Paul Edward Baltimore City Hospitals, Baltimore, Md. 

Kindt, Willard Freed Allentown General Hospital, Allentown, Pa. 

King, Victor Francis St. Agnes Hospital, Baltimore, Md. 

KrpNis, Davdd Morris The Johns Hopkins Hospital, Baltimore, Md. 

Knipp, Harry Lester St. Agnes Hospital, Baltimore, Md. 

Kramer, Howard Calvin Mercy Hospital, Baltimore, Md. 

Lamb, William Eugene Gallinger Municipal Hospital, Washington, D. C. 

Lanning, Theodore Reuney Kings County Hospital, Brooklyn, N. Y. 

Leibman, Jack Mount Zion Hospital, San Francisco, Cal. 

Ley, Leo Henry, Jr. St. Agnes Hospital, Baltimore, Md. 

Lister, Leonard Melvin Barnes Hospital, St. Louis, Mo. 

MacDonald, James Melvtn U. S. Naval Hospital, Bethesda, Md. 

McFadden, Earl Boyd Spartanburg General Hospital, Spartanburg, S. C. 

McFadden, John William St. Luke's Hospital, Cleveland, Ohio 

McGrady, Charles Winfred, Jr Gallinger Municipal Hospital, Washington, D. C. 

McGrady, Kathleen Reilly Gallinger Municipal Hospital, Washington, D. C. 

Mendez Bryan, Ricardo Tomas Fajardo District Hospital, Fajardo, Puerto Rico 

Metcalf, John Shelby, Jr University Hospital, Baltimore, Md. 

Mosser, Robert Schaaf University Hospital, Baltimore, Md. 

Mutter, Arthur Zelig Michael Reese Hospital, Chicago, 111. 

Myers, Donald Johnson McKeesport Hospital, McKeesport, Pa. 

Nygren, Edward Joseph 

The New York Hospital, Cornell Medical Center, New York, N. Y. 

Orth, John Stambaugh Tripler General Hospital, Oahu, Ha. 

Packard, Douglas Richard Elizabeth Buxton Hospital, Newport News, Va. 

Pencheff, Dorris Marie Los Angeles County General Hospital, Los Angeles, Cal. 

Pertlla, Frank Robert Mercy Hospital, Baltimore, Md. 

Perry, Henry David, Jr University Hospital, Baltimore, Md. 

Reeser, Guy McClelland, Jr Lutheran Hospital of Maryland, Inc., Baltimore, Md. 

Reeves, Henry Gray, Jr University Hospital, Baltimore, Md. 



SCHOOL OF MEDICINE 101 

Rex, Eugene Braiden University Hospital, Baltimore, Md. 

Reynolds, Georgia Gallinger Municipal Hospital, Washington, D. C. 

Richardson, Aubrey De Vaughn University Hospital, Baltimore, Md. 

Rombro, Marvin Jay Lutheran Hospital of Maryland, Inc., Baltimore, Md. 

Rowland, Harry Shepard, Jr Jersey City Medical Center, Jersey City, N. J. 

Saavedra Amador, Armando St. Joseph's Hospital, Baltimore, Md. 

Schmale, Arthur Henry, Jr University Hospital, Baltimore, Md. 

Scott, Roger David University Hospital, Baltimore, Md. 

Scully, John Thorsen Youngstown Hospital Association, Youngstown, Ohio 

Shea, William Harold Holland Mercy Hospital, Baltimore, Md. 

Sherry, Samuel Norman Sinai Hospital, Baltimore, Md. 

Simmons, Leslie Dale Mercy Hospital, Baltimore, Md. 

Sd?ple, Edward M Mercy Hospital, Baltimore, Md. 

Sklpton, Roy Kennedy University Hospital, Baltimore, Md. 

Solomon, Davtd Milton Sinai Hospital, Baltimore, Md. 

Stone, John Hosktns Mercy Hospital, Baltimore, Md. 

Sutton, Julian Theoplous Charlotte Memorial Hospital, Charlotte, N. C. 

Tobias, Richard Boyd The Williamsport Hospital, Williamsport, Pa. 

Twigg, Homer Lee, Jr U. S. Marine Hospital, Boston, Mass. 

Udel, Melvtn U. S. Marine Hospital, Baltimore, Md. 

Venrose, Robert James U. S. Marine Hospital, New Orleans, La. 

Watson, Charles Polk, Jr University Hospital, Baltimore, Md. 

Weekley, Robert Dean St. Luke's Hospital, Cleveland, Ohio 

Wheelwright, Harvey Pearse U. S. Marine Hospital, Seattle, Wash. 

Williams, Charles Ray U. S. Marine Hospital, San Diego, Cal. 

York, Shelley Clyde, Jr Medical College of Virginia, Richmond, Va. 

York, Thomas Luther U. S. Marine Hospital, Galveston, Texas 

Young, Calvin Lessey U. S. Marine Hospital, Staten Island, N. Y. 

MATRICULANTS 
SENIOR CLASS, SEPTEMBER 21, 1950 TO JUNE 9, 1951 

Ager, Law Lamar, B.S., University of North Carolina, School of Medicine, Septem- 
ber 1947 to June 1949 North Carolina 

Arthur, Robert Key, Jr., B.S., Mercer University, 1948 Georgia 

Barthel, John Paul, Western Maryland College Maryland 

Beardsley, Earl Miller, University of Maryland Maryland 

Bell, Arthur Keith, A.B., Oberlin College, 1947 Maryland 

Bilder, Joseph, Jr., B.S., University of Akron, 1944 Ohio 

Birely, Beverly Robert, University of Maryland Maryland 

Blades, Nancy, A.B., Connecticut College, 1947 New Jersey 

Bossard, John Wesley, A.B., Duke University, 1947 Maryland 

Brannon, John Vandale, B.S., Fairmont State Teachers College, 1948. .West Virginia 

Buell, John Russell, Jr., University of Maryland Maryland 

Christopher, Russell Lee, A.B., Bowdoin College, 1947 Massachusetts 

Clemmens, Raymond Leopold, B.S., Loyola College, 1947 Maryland 

Copfman, Kaohlin Miner, A.B., Western Maryland College, 1947 Pennsylvania 

Cohen, Solomon, A.B., University of Denver, 1947 Maryland 

Curanzy, Raymond Ralph, B.S., Juniata College, 1947 Pennsylvania 

Deckelbaum, Joseph, B.S., University of Maryland, 1947 Maryland 

Dettbarn, Ernest Albert, B.S., Randolph-Macon, 1947 Maryland 

Donner, Leon, B.S., State Teachers College, 1942 Maryland 

Dudley, Winston Clark, A.B., Oberlin College, 1943 Massachusetts 

Dunn, George Mitchell, Jr., George Washington University. . . .District of Columbia 
Dunigan, William Andrew, A.B., University of North Carolina, School of Medi- 
cine, September 1947 to June 1949 North Carolina 



102 UNIVERSITY OF MARYLAND 

Edwards, David Everett, University of Maryland District of Columbia 

Edwards, William Hunter, Jr., A.B., Johns Hopkins University, 1940 Maryland 

Esmond, William George, B.S., University of Maryland, 1940 Maryland 

Evans, Otis Drdell, Jr., B.S., Davidson College, 1947 North Carolina 

Ferguson, Charles Kirkpatrick, Muskingum College Kansas 

Fitzgerald, Joseph Carroll, Middlebury College, 1947 Maryland 

Fullilove, Jack, University of Georgia Georgia 

Gallaher, James Patrick, B.A., West Virginia University, 1947 West Virginia 

Garcia Palmieri, Mario Ruben, B.S., University of Puerto Rico Puerto Rico 

Gardner, Francis, Sujney, Jr., A.B., University of North Carolina, School of 

Medicine, September 1947 to June 1949 North Carolina 

Gates, John Butler, University of Wisconsin Wisconsin 

Gordon, Benjamin Dichter, B.A., Amherst College, 1947 New York 

Hatem, Frederick Joseph, B.S., Georgetown University, 1947 Maryland 

Hopkins, Robert Charles, B.S., Allegheny College, 1946 Pennsylvania 

Iten, George Joseph, A.B., Goshen College, 1946 California 

Johnson, Frederick Miller, B.S., M.S., University of Maryland, 1943-1947 

District of Columbia 

Johnson, Wallace Edward, Wesleyan University New Hampshire 

Kaschel, Paul Edward, A.B., Wheaton College, 1947 New Jersey 

Kindt, Wlllard Freed, Muhlenberg College Pennsylvania 

King, Victor Francis, University of Maryland Maryland 

Kipnis, David Morris, A.B., A.M., Johns Hopkins University, 1945-1949. . .Maryland 

Knipp, Harry Lester, Loyola College Maryland 

Kramer, Howard Calvin, University of Maryland Maryland 

Lamb, William Eugene, B.S., University of Florida, 1947 Florida 

Lanning, Theodore Reuney, B.S., Springfield College, 1944 New Jersey 

Leibman, Jack, A.B., Johns Hopkins University, 1947 Maryland 

Ley, Leo Henry, Jr., ML St. Mary's College of Maryland Maryland 

Lister, Leonard Melvin, Loyola College Maryland 

MacDonald, James Melvin, B.S., Loyola College, 1947 Maryland 

McFadden, Earl Boyd, B.S., University of Maryland, 1947 Maryland 

McFadden, John William, Mt. Union College Ohio 

McGrady, Charles Winifred, Jr., A.B., Emory University, 1947 Georgia 

McGrady, Kathleen Reilly, B.S., Long Island University, 1947 New York 

Mendez Bryan, Ricardo Tomas, University of Puerto Rico Puerto Rico 

Metcalf, John Shelby, Jr., B.S., University of California, 1950 California 

Mosser, Robert Schaaf, B.S., University of Maryland, 1949 Maryland 

Mutter, Arthur Zelig, B.S., Franklin & Marshall College, 1947 Maryland 

Myers, Donald Johnson, B.S., Bethany College, 1934 Ohio 

Nygren, Edward Joseph A.B., Western Maryland College, 1947 Maryland 

Orth, John Stambaugh, University of Maryland Maryland 

Packard, Douglas Richard, University of Maryland Maryland 

Pencheff, Dorris Marle, A.B., University of California, 1946 California 

Perilla, Frank Robert, B.S., University of Maryland, 1947 Maryland 

Perry, Henry David, Jr., A.B., Emory University, 1947 Florida 

Reeser, Guy McClelland, Jr., A.B., Western Maryland College, 1947 Maryland 

Reeves, Henry Gray, Jr., B.S., Wake Forest College, 1947 North Carolina 

Rex, Eugene Braiden, Vanderbilt College Colorado 

Reynolds, Georgia, A.B., Western Maryland College, 1947 Maryland 

Richardson, Aubrey DeVaughn, B.S., University of North Carolina, School of 

Medicine, Sept. 1947 to June 1949 North Carolina 

Rombro, Marvin Jay, A.B., Bucknell University, 1947 Maryland 

Rowland, Harry Shepard, Jr., A.B., Wesleyan University, 1947 New Jersey 

Saavedra Amador, Armando, University of Puerto Rico Puerto Rico 

Schmale, Arthur Henry, Jr. Pennsylvania State College Nebraska 

Scott, Roger, David, University of Virginia Florida 

Scully, John Thorsen, Indiana University Indiana 

Shea, William Harold Holland, B.S., Loyola College, 1947 Maryland 

Sherry, Samuel Norman, B.S., University of Maryland, 1949 Maryland 

Simmons, Leslie Dale, B.S., West Virginia University, School of Medicine 

Sept. 1947 to June 1949 West Virginia 

Sipple, Edward M., B.A., Earlham College, 1949 Maryland 



SCHOOL OF MEDICINE 103 

Skipton, Roy Kennedy, B.S., University of Maryland, 1942 Maryland 

Solomon, David Milton, University of Maryland Maryland 

Stone, John Hoskins, B.S., University of Maryland Maryland 

Sutton, Julian Theoplous, A.B., University of North Carolina, School of Medi- 
cine, September 1947 to June 1949 North Carolina 

Tobias, Richard Boyd, B.S., Bucknell University, 1947 Pennsylvania 

Twigg, Homer Lee, Jr., University of Maryland Maryland 

Udel, Melvtn, A.B., University of Maryland, 1947 Maryland 

Venrose, Robert James, A.B., University of Michigan, 1946 Ohio 

Watson, Charles Polk, Jr., A.B., West Virginia University, 1947 West Virginia 

Weekley, Robert Dean, B.S., Heidelberg College, 1947 Ohio 

Wheelright, Harvey Pe arse, Brigham Young University Utah 

Williams, Charles Ray, A.B., Gettsburg College, 1947 Maryland 

York, Shelley Clyde, Jr., B.S., Guilford College, 1947 North Carolina 

York, Thomas Luther, A.B., University of North Carolina, School of Medicine 

Sept. 1947 to June 1949 North Carolina 

Young, Calvin Lessey, A.B., Haverford College, 1947 Maryland 

JUNIOR CLASS, SEPTEMBER 21, 1950 TO JUNE 9, 1951 

Adams, Charles Baird, Jr., University of Maryland Maryland 

Adelstein, Benjamin Alfred, A.B., University of Pennsylvania, 1948 Pennsylvania 

Adkins, Charles Glen, West Virginia University West Virginia 

Ahlquist, Richard Elmer, Jr., A.B., Stanford University, 1948 Washington 

Alderman, George Carl, Jr., B.S., Loyola College, 1949 Maryland 

Andrews, James William, B.S., Muskingum College, 1948 Ohio 

Atkins, Raymond Melvln, University of Maryland Maryland 

Bakal, Daniel, B.S., Loyola College, 1948 Maryland 

Baker, Timothy Danford, A.B., Johns Hopkins University, 1948 Maryland 

Bergofsky, Edward Harold, University of Maryland Maryland 

Berrios, Osvaldo, University of Puerto Rico Puerto Rico 

Bridges, Jack Arthur, University of Maryland Maryland 

Brittain, Lowell Ellis, A.B., University of North Carolina, School of Medicine, 

September 1948 to June 1950 North Carolina 

Brooks, James Burch, B.S., Loyola College, 1948 Maryland 

Brown, William Morris, Jr., A.B., Mercer University, 1948 Georgia 

Carroll, John Edward, Jr., Loyola College Maryland 

Carson, Jack Oliver, B.S., University of North Carolina, School of Medicine, 

September 1948 to June 1950 North Carolina 

Clyman, Daniel, B.S., University of Maryland, 1948 Maryland 

Cohen, Phtn, Duke University Maryland 

Culpepper, Stuart Pitner, B.S., University of Georgia, 1948 Florida 

Devlin, Andrew Joseph, B.S., Gonzaga University, 1948 Washington 

Diggs, Andrew Monroe, B.S., University of North Carolina, School of Medicine, 

September 1948 to June 1950 North Carolina 

DiGiovanni, Anthony John, A.B., Johns Hopkins University, 1948 Maryland 

Douglas, Robert Arnold, B.S., /. B. Stetson University, 1948 Florida 

Douglass, Robert Corl, Jr., B.S., University of Toledo, 1947 Ohio 

Dunford, William Stanley, Jr., B.S., Brigham Young University, 1948 Utah 

Eakle, Burke Eldridge, West Virginia University West Virginia 

Eckert, Herbert Lewis, University of Maryland Maryland 

Egbert, Lawrence Deems, Jr., A.B., Johns Hopkins University, 1948 Maryland 

Elgin, Lee William, Jr., University of Florida Florida 

Elliott, Charles Stanley, Emory University Florida 

Feski, Joseph Paul, University of Pittsburgh Pennsylvania 

Fine, Jack, University of Maryland Maryland 

Foley, Michael Joseph, West Virginia University West Virginia 

Fritz, Louis Albert, B.S., Loyola College, 1948 Maryland 

Gebhardt, Robert William, University of Maryland Maryland 

Gilliam, Charles Franklin, A.B., University of North Carolina, School of Medi- 
cine, September 1948 to June 1950 North Carolina 

Gislason, Paul Harold, A.B., University of North Dakota, 1948 North Dakota 

Gonzalez, Luis Felipe, University of Maryland Puerto Rico 

Gore, Jay Calvin, A.B., Western Maryland College, 1948 Maryland 



104 UNIVERSITY OF MARYLAND 

Grabill, James Rodney, Georgetown University, A merican University Maryland 

Graham, David Eric, B.S., University of North Carolina, Medical School, Sep- 
tember 1948 to June 1950 North Carolina 

Graybeal, Clarence Edward, University of Maryland Maryland 

Greco, William Richard, University of Maryland Maryland 

Grubb, Robert Alvin, University of Maryland Maryland 

Hankoff, Leon Dudley, University of Maryland Maryland 

Harris, William Benjamine, A.B., University of North Carolina, School of Medi- 
cine, September 1948 to June 1950 North Carolina 

Heimer, William Lenox, B.S., University of Maryland, 1948 Maryland 

Holmes, Charles Martin, University of Miami Maryland 

Houck, Romulus Vance, Jr., University of Maryland Maryland 

Hudgins, William Baird, A.B., Emory University, 1948 Georgia 

Hunter, DeWitt Talmade, Jr., B.S., U. S. Naval Academy, 1945 Virginia 

Hunter, Laurel Mullins, A.B., W esthampton College, 1948 Maryland 

Hyatt, Irvtn, B.S., University of Maryland Maryland 

Keller, Franklin Lloyd, A.B., Gettysburg College, 1945 Maryland 

Kline, Frank Menefee, University of Maryland Maryland 

Knell, Joseph Anthony, Jr., A.B., Loyola College, 1948 Maryland 

Krager, John Martin, B.S., Loyola College, 1948 Maryland 

Kramer, Irvtn, New York University Maryland 

Krteger, Morton Morris, University of Maryland Maryland 

Lapp, Herbert Walter, Seton Hall College New Jersey 

Lightbody, Charles Harry, A.B., Colby College, 1948 Maine 

Love, Robert George, B.S., Massachusetts State College, 1947 Massachusetts 

Mathews, William Allen, Westminster College, A.B., Wittenberg College Ohio 

McKay, John Nelson, Ohio Wesleyan University, Gettysburg College Maryland 

Olsen, Richard Young, A.B., University of California, 1948 California 

Perry, Benton Bloch, B.S., University of Chicago, 1947 Maryland 

Pillsbury, William Andrew, Jr., University of Oregon, Loyola College Maryland 

Potter, Vance Edward, University of Maryland Maryland 

Rabinowich, Malcolm Lee, University of Maryland Maryland 

Ramirez-Santisteban, Gilberto, University of Puerto Rico Puerto Rico 

Rappeport, Jonas Ralph, University of Maryland Maryland 

Rasmussen-Taxdal, David Samuel, University of Maryland Pennsylvania 

Reed, Julian Ward, B.S., University of Maryland Maryland 

Rosson, William Daniel, University of Maryland Maryland 

Schtmmel, Bella Faye, B.S., University of Michigan, 1948 Maryland 

Sharrett, John Oliver, University of Virginia Maryland 

Shoff, Mahlon James, A.B., University of Delaware, 1948 Delaware 

Sindler, Richard Arnold, A.B., Johns Hopkins University, 1948 Maryland 

Slager, Ursula Traugott, A.B., Wellesley College, 1948 Maryland 

Smith, Bolyston Dandrtdge, West Virginia University West Virginia 

Smith, George Herbert, A.B., Clark University, 1948 Maine 

Smoot, Aubrey Cannon, Jr., University of Delaware Delaware 

Spritz, Norton, A.B., Johns Hopkins University, 1948 Maryland 

Stambler, Alvin Abraham, University of Maryland Maryland 

Starling, Charles Ray, B.S., University of North Carolina, Scliool of Medicine, 

September 1948 to June 1950 North Carolina 

Trace, Robert James, University of Wisconsin Wisconsin 

Troutman, Belk Connor, University of North Carolina, School of Medicine, 

September 1948 to June 1950 North Carolina 

Vicens, Carlos Nathaniel, B.S., University of Puerto Rico, 1948 Puerto Rico 

Wallace, Scott, Pyper, A.B., University of Utah, 1948 Utah 

Walsh, Harry Martin, B. S., Washington College, 1948 Maryland 

Warren, Bryan Pope, Jr., University of Maryland Maryland 

Watters, John Lord, A.B., University of North Carolina, School of Medicine, 

September 1948 to June 1950 North Carolina 

Weeks, Howard Nelson, B.S., Franklin & Marshall, 1948 Maryland 

Wildberger, Albert John, A.B., Western Maryland College, 1948 Maryland 

Wilkinson, John Ross, Jr., A.B., University of North Carolina, School of Medicine, 

September 1948 to June 1950 North Carolina 

Wolfel, Donald Anthony, University of Maryland Maryland 

Wolverton, William Roger, A.B., West Virginia University, 1948 West Virginia 



SCHOOL OF MEDICINE 105 

SOPHOMORE CLASS, SEPTEMBER 21, 1950 TO JUNE 9, 1951 

Arp, Louis Croft, Jr., A.B., State University of Iowa, 1949 Illinois 

Baldwin, Richard Moffett, B.S., Loyola College, 1949 Maryland 

Banks, James Leroy, Jr., B.S., Furman University, 1949 South Carolina 

Bastian, Grace Arlene, B.S., College of Notre Dame of Maryland, 1949 Maryland 

Beck, George Henry, A.B., Western Maryland College, 1949 Maryland 

Berkow, Robert, B.S., University of Maryland, 1949 Maryland 

Blumenfeld, Samuel, A.B., University of Maryland, 1949 Maryland 

Boggs, James Ernest, A.B., West Virginia University, 1949 West Virginia 

Bove, Joseph Richard, B.S., University of Maryland New Jersey 

Brinkley, George Ross, Jr., A.B., West Virginia University, 1949 West Virginia 

Burkart, Thomas Joseph, B.S., Loyola College, 1949 Ohio 

Byerly, Walter Houch, A.B., Johns Hopkins University, 1949 Maryland 

Byrnes, Bernard Joseph, Jr., B.S., Loyola College, 1949 Maryland 

Carroll, Charles Fisher, Jr., B.S., Guilford College, 1949 North Carolina 

Carter, Donald Sweetser, Duke University Maryland 

Clift, John Vinton, B.S., Hampden-Sydney College, 1949 Maryland 

Codington, John Bonnell, B.S., Davidson College, 1949 North Carolina 

Cohen, Jerome, B.S., University of Maryland Maryland 

Colon-Lugo, Salomon, University of Puerto Rico Puerto Rico 

Cook, Arthur John, A.B., Emory University, 1949 Georgia 

Doerner, Wyand Francis, Jr., B.S., Mt. St. Mary's College, 1949 Maryland 

Dowell, Rowland Judson, University of Utah Utah 

Dumler, John Donald, B.S., University of Maryland Maryland 

Edlow, Jules Bernard, B.S., University of Maryland Maryland 

Eye, Harry Luke, A.B., West Virginia University, 1949 West Virginia 

Firor, Hugh Valentine, University of Georgia Georgia 

Flax, Leonard Harold, B.S., University of Maryland Maryland 

Freeman, Sylvan, B.S., University of Maryland, 1949 Maryland 

Garlock, Frederick Adams, B.S., University of Maryland Maryland 

Garrison, Joseph Shermer, 3d, A.B., Western Maryland College, 1949 Maryland 

Gevas, George, B.S., University of Maryland, 1949 Maryland 

Gillotte, Joseph Patrick, B.S., University of Maryland Connecticut 

Glick, Leonard Barry, B.S., University of Maryland Maryland 

Goldstein, Robert Bruce, University of Maryland Maryland 

Hartman, John McMaster, A.B., West Virginia University, 1949 West Virginia 

Heisse, John Wilbur, Jr., A.B., Johns Hopkins University, 1949 Maryland 

Henson, Kenneth Clifford, B.S., Salem College, 1949 Maryland 

Herbert, Thomas Franklyn, Johns Hopkins University Maryland 

Hess, Charles Franklin, A.B., McPherson College, 1949 Pennsylvania 

Himmel wrighT, George Overton, B.S., University of Maryland Maryland 

Holder, William Lewis, A.B., Emory University, 1949 Georgia 

Jones, Henry Albert, Jr., Johns Hopkins University Ma